415 - Improving Distribution of After-Visit Summaries: A Resident Quality Improvement Project

Poster Number: 415
Publication Number: 415.445

Casey Mason, NY-Presbyterian, NEW YORK, NY, United States; Mariellen Lane, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Steve Caddle, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Suzanne Friedman, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States

Background: After-Visit Summaries (AVS) are a tool used by providers through the Electronic Medical Record (EMR). The AVS can be printed with visit closure and accessed via patient portals to provide patient visit details, medications, plans, and future appointments. The AVS relays patient information promoting health literacy, allows for closed loop communication, and fulfills the Centers for Medicare and Medicaid requirement for interoperable exchange of health information. We sought to employ quality improvement (QI) methodology to promote distribution of AVS utilization.

Objective: Our project aims to increase the distribution of the printed AVS for all in-person visits from 32% to 75%.

Design/Methods: A resident-led QI project was undertaken between August 2020 to May 2021 at a NewYork-Presbyterian faculty-resident pediatric practice in Upper Manhattan providing care for an urban, underserved population. Plan-Do-Study-Act (PDSA) cycles were developed based on identified key drivers (Figure 1). AVS distribution was tracked as an outcome measure based on the number of AVS printed per number of visits for both nurses and providers. Data was collected through November 2021 to examine sustainability.

Results: The run chart (Figure 2) demonstrates the changes in ratio of AVS distribution over the course of the initiative. Through the various interventions noted, AVS distribution increased from 32% to a peak of 75%, thus achieving our initial goal.  Following the implementation of interventions, the centerline shifted. A period of sustainability was demonstrated at the completion of the year-long project with median print ratio of 54% in the weeks following the end of the key driver interventions, an increase from the primary starting point of the study. The most successful interventions were education on the AVS and developing a consistent work-flow for providers. Interventions aimed at nursing only visits were least successful. Conclusion(s): The AVS is an important and necessary tool for promoting patient health literacy and communication between patients and providers. Through the employment of QI methodology and PDSA cycles, our project achieved its initial goal. The decline in AVS distribution noted at the end of the project with a period of sustainability of 54% demonstrates the importance of further support for AVS education and work-flow interventions. Our project was able to demonstrate actionable and sustainable ways in which to incorporate AVS distribution into a practice, modeling opportunities for spread to other practices.
Figure 1: Key Drier Diagram
Figure 2: Run ChartPDSA Cycle Legend
Education: All staff educated on importance of AVS
Spurious Printing: Spurious data points noting occurrence of nursing printing of all AVS to mail to patients
Printing Plan: Signage added to indicate location of printers from each computer
Workflow Reminder: Signage added in key locations to remind providers to print AVS at end of each encounter
Nursing Engagement: Nursing education in regards to AVS printing
Workflow Reminder: Signage added in key locations to remind nurses to print AVS at end of each encounter
Provider Feedback: Breakdown of AVS distribution achievements at this point in the project for each clinic day
End of Project: Official completion of year-long AVS distribution QI project