Dr. Tiffany Wong, MD, is an internal medicine resident at the University of Pennsylvania in Philadelphia, PA. She spoke with Nathaniel Reisinger (@nephrothaniel), AJKDBlog guest contributor, to discuss her abstract presented at the National Kidney Foundation’s 2017 Spring Clinical Meeting: Improving the Transition of Care for Dialysis Patients Between Hospital Discharge and Return to the Dialysis Unit.
AJKDBlog: What was the general thrust of your project?
Dr. Wong: My poster is about a quality improvement project that I started working on last year. It’s a tagalong to one of the renal fellows’ ongoing quality improvement projects about improving the transition of care between hospital discharge and return to the dialysis unit. My part of the project focused specifically on the communication aspect. This project really worked on different aspects. One of the deficits that we found was that fellows didn’t know when patients were being discharged until they fell off their lists the next day. We worked with the Penn Center for Innovation and built an automated discharge alert so that every time a dialysis patient was discharged from the hospital the covering renal fellow was automatically notified as well as the dialysis social worker. It allowed them to intervene before the patient physically left the hospital with regards to things like medication reconciliation and what antibiotics were available at the dialysis center as well.
AJKDBlog: How do you think this is going to improve outcomes for the patients involved?
Dr. Wong: I think this is just another layer of trying to work with inpatient and outpatient and making that bridge so its safer for patients. There are a lot of dialysis centers that are not necessarily connected with our hospital and it’s helpful to build in this extra layer of safety so that we have the time to contact the dialysis centers to give them the discharge summary and relay changes that were made on the inpatient side. These are things that should be happening and hopefully this automated alert will help facilitate that.
AJKDBlog: What did you learn in the process?
Dr. Wong: I learned that it’s difficult to enact change. You really have to have buy-in and what was really helpful is that I had buy-in from the fellows, I had buy-in from the nephrology social worker, and I had buy-in from the housestaff. The difficult part of the project of this project is that our hospital has now transitioned to Epic and this automated discharge alert system has to be readjusted to mine data from Epic.
AJKDBlog: Where do you see this taking you in the future? What’s the next step?
Dr. Wong: I think the next step is trying to build this within Epic, but I hope to continue to work on quality improvement projects for dialysis patients because I think they are a particularly vulnerable population, especially with regard to hospital readmission and ED readmission rates within 30 days. Things like this can add another layer of safety and help to minimize those risks in the future.
AJKDBlog: One more question, you mentioned the Penn Center for Innovation. How have they been helpful in planning and executing your project?
Dr. Wong: They are immensely helpful. I don’t think I would have been able to get this project off the ground without their help. They are really unique in that they look at QI issues with a different perspective. They really try and force you to go through the PDSA cycle to think things through and use root-cause analysis to think outside the box. The technology that they have is phenomenal. I would not have been able to build that kind of program myself.
AJKDBlog: Thanks a lot for taking the time to talk to us!