SHM Converge Scientific Abstract ePoster Gallery-Appointment Liaison Integration and Scheduling Optimization

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This project focused on improving primary care follow-up scheduling before hospital discharge to reduce 30-day readmissions, strengthen care coordination, and improve patient satisfaction. Under Hospital Value-Based Purchasing, readmission rates prompted the initiative after audits showed many patients left without timely follow-up, along with fragmented communication between inpatient teams and outpatient scheduling.<br /><br />To address this gap, appointment liaisons were embedded into the discharge workflow to schedule follow-up visits in real time. Low-risk patients discharged home or with home health were targeted for PCP scheduling, while moderate- and high-risk patients were directed to transition clinic appointments. Epic EMR tools were used to flag time-sensitive discharges, support workflow standardization, and improve communication. The team also provided interdisciplinary training so inpatient and outpatient staff understood expectations and could work more consistently across settings.<br /><br />A blended learning approach was used to train unlicensed personnel on Epic scheduling and documentation. Training included self-paced eLearning, live virtual instruction, and hands-on simulation. This helped reduce scheduling errors, improve efficiency, and ensure staff understood how their work supported patient safety and continuity of care.<br /><br />Results showed meaningful improvement: pre-discharge appointment scheduling increased from about 41.5% to 79.2%. During the pilot, 74% of patients attended their PCP visit, and those who completed follow-up were 13% less likely to be readmitted than those who did not. Staff reported better communication and workflow efficiency, and patient satisfaction related to discharge planning and care continuity improved.<br /><br />Overall, the project demonstrated that embedding appointment liaisons, using EMR-based workflow supports, and training staff effectively can improve transitions of care, reduce missed follow-ups, and support better patient outcomes.

Asset Subtitle

Elizabeth Kiker

Meta Tag

Author List Elizabeth Kiker, Misty Fontana

Category Innovations

Concept Continuity of Care

Concept Outpatient Primary Care Follow-up

Concept Hospital Discharge

Concept Appointment Adherence

Concept 30-Day Readmission

Distinguished Non-Finalist

Presenter Organization Advocate Health / Atrium Health

Presenting Author Elizabeth Kiker

Track Quality Improvement

Keywords

primary care follow-up

hospital discharge

30-day readmissions

care coordination

patient satisfaction

Epic EMR

appointment liaisons

transition clinic

discharge workflow

readmission reduction

Continuity of Care

Outpatient Primary Care Follow-up

Hospital Discharge

Appointment Adherence

30-Day Readmission