285 - Expanding Hospital Wide Utilization of the Problem List at Discharge for Inpatient Divisions

Publication Number: 285.4601

Samantha Neumeier, Wright State University Boonshoft School of Medicine, Dayton, OH, United States; Maddie Van Dorpe, Dayton Children's Hospital - - Dayton, OH, Dayton, OH, United States; Mellissa Mahabee, Dayton Children's Hospital, Dayton, OH, United States; Abiodun Omoloja, Dayton Children's Hospital, Dayton, OH, United States; Jorde Spitler, Dayton Childrens Hospital, Troy, OH, United States; Beth Williams, Dayton Children's Hospital, Dayton, OH, United States

Background: A dynamic list of clinically relevant diagnoses, procedures and psychosocial issues, the problem list (PL) is an essential part of the medical record. Underutilization of the PL impedes its ability to impact provider communication, accuracy of documentation, classification of chronic diagnoses, enlisting patients in research, patient experience, cost savings and clinical decision support. At our institution, the development of a hospital-wide PL policy prompted efforts to improve consistency in maintaining an up-to-date PL.

Objective: The team chose to focus on improving reconciliation of the PL at discharge through the primary aim of increasing percentage of inpatient PLs updated within 24 hours of discharge from 35% to 85% by 8/2025. As a secondary measure the team aimed to increase the percentage of inpatient PLs marked as reviewed at discharge from 14% to 85% by 8/2025.

Design/Methods: As Plan-Do-Study-Act cycles demonstrated improvement, interventions were adapted and spread throughout other inpatient divisions. Current inpatient divisions include Hematology/Oncology, the Transitional Care Unit, Hospital Medicine, NICU and PICU. Monthly metrics are collected on both hospital wide and division specific data. Key drivers include knowledge and consensus on PL maintenance, standard PL workflow, provider engagement, EHR enhancements, and optimal PL documentation. The common interventions applied to these units focused initially on education, workplace reminders, division focused EHR enhancements, and sharing division and/or individual compliance data. In addition, some divisions have incorporated PL metrics into the quality goals for their providers.

Results: Since the onset of the project, the mean has shifted from 35% to 68% for updating the PL within 24 hours of discharge. Similarly, marking the PL as reviewed within 24 hours of discharge has shifted from a mean of 14% to 57%.

Conclusion(s): Updating and marking the PL as reviewed has shown significant improvement since starting the hospital wide project. Two EHR enhancements that were impactful included the PL department preference list and prompting PL reconciliation in discharge summaries. These improvements can be attributed to the effectiveness of applying general interventions that have shown previous success and then adapting those interventions to each division’s specific needs. This allows for an individualized approach to quality improvement meeting the needs of each division. The next steps include identifying additional areas for project spread and automatic removal of select problems from PL.

Key Driver Diagram
Hospital Wide Problem List KDD.pdfSummary of Smart Aims, Key Drivers, and project Interventions

Hospital Wide Percentage of Updating the Problem List at Discharge
PL Updated Control Chart Hospital Wide.pdfP-chart

Hospital Wide Percentage of Problem Lists Marked as Reviewed at Discharge
PL Control Chart Hospital Wide Discharge Reviewed.pdfP-chart

Key Driver Diagram
Hospital Wide Problem List KDD.pdfSummary of Smart Aims, Key Drivers, and project Interventions

Hospital Wide Percentage of Updating the Problem List at Discharge
PL Updated Control Chart Hospital Wide.pdfP-chart

Hospital Wide Percentage of Problem Lists Marked as Reviewed at Discharge
PL Control Chart Hospital Wide Discharge Reviewed.pdfP-chart