AHRQ Innovations Exchange | Psychiatric Hospital Streamlines Patient Transfer Process to Outpatient Clinics, Reducing Scheduling Time and Time to First Appointment and Nearly Doubling Monthly Transfers

Psychiatric Hospital Streamlines Patient Transfer Process to Outpatient Clinics, Reducing Scheduling Time and Time to First Appointment and Nearly Doubling Monthly Transfers

Snapshot
Summary
Langley Porter Psychiatric Hospital and Clinics used Toyota Production System principles to streamline the process by which patients are transferred to outpatient clinics. Key improvements included obtaining advanced insurance authorization, enhancing patient involvement, standardizing and simplifying referral request and appointment scheduling processes, and using automated systems to track referrals and scheduling and to measure performance, thus enabling the rapid identification of sources of error and delay. The program significantly reduced scheduling time, time to the patient's first appointment, and communication errors, leading to a near doubling in the number of patient transfers completed each month.

Evidence Rating
Moderate: The evidence is based on pre- and post-implementation comparisons of the amount of time needed to schedule appointments, time to the first appointment, and number of monthly transfers, along with post-implementation trend data on communication errors.

Developing Organizations
Langley Porter Psychiatric Hospital and Clinics


Date First Implemented
2006

Patient Population
Vulnerable Populations > Mentally ill

What They Did
Problem Addressed
Efficient transfer of patients from psychiatric hospitals to outpatient clinics for follow up care is a critical step in the successful treatment of adults with severe and persistent mental illness. Successful transfers require prompt scheduling and coordination of care. A number of obstacles frequently lead to delays in these efforts, causing care fragmentation and raising patients' likelihood of continued mental health problems.

Need for prompt scheduling and care coordination: Many patients with severe mental illness require quick follow up care; however, transfers cannot occur until a variety of scheduling and care coordination steps take place, including making the transfer request, approving the transfer, identifying an appropriate clinic, contacting the clinic, scheduling an appointment, getting the clinician all appropriate records and information, and giving the patient the new clinician's contact information in case questions arise before the first appointment.1

Obstacles to prompt transfer: Obstacles to timely transfers include complex referral systems requiring numerous individual staff reviews and approvals, communication errors between the hospital and the patient or the outpatient clinic, and poor comprehension by patients related to the importance of prompt followup. For example, at Langley Porter, transfers could originate from five different sources: outpatient assessment clinics, outpatient staff psychotherapists, inpatient units, the partial hospitalization program, and the consult-liaison service based in an adjacent medical hospital. This challenge was compounded by constantly changing clinicians, because rotating residents staffed outpatient clinics.1

Significant treatment consequences: Arranging a follow up appointment within a few days rather than a few weeks increases the likelihood of successful transfer and the establishment of a positive therapeutic relationship. By contrast, delayed transfers increase the likelihood that patients will fail to receive or complete follow up treatment. As a result, they are more likely to experience symptom exacerbations, require repeat hospitalizations, and attempt or commit suicide.2

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AHRQ Innovations Exchange | Psychiatric Hospital Streamlines Patient Transfer Process to Outpatient Clinics, Reducing Scheduling Time and Time to First Appointment and Nearly Doubling Monthly Transfers