Tapping into Technology: Using Virtual Methods to Improve a Cardiology Transition Clinic
Presented By:
Anait Hokhikyan, BSN, RN, CCRN; Courtney Porter, MPH, CPHQ; Roberta Williams, MD
Children's Hospital Los Angeles
ahokhikyan@chla.usc.eduOverview:
Purpose: The need for a structured process for healthcare transition is well-documented. In our previous experience with an in-person cardiology transition clinic for adolescents and young adults, there was a high no-show rate and inefficient coordination of patient and provider schedules. The purpose of this project was to reduce the no-show rate by converting the transition clinic to a telehealth format, digitalize resources, and reduce the total visit time.
Project Design: In July 2021, Transition Clinic was converted to telehealth format with a nurse leader, scheduler, and in-house cardiologist with experience in life-long course of disease and specific developmental and mental health issues of the population. Target age range was 17-21 years. The process for referral from the primary cardiologist was streamlined to capture appropriate patients. Visits focused on assessment of readiness for self-care and health literacy, education about navigating adult healthcare systems, natural history of disease, and plans for timing and destination of adult care for cardiology. Reproductive and mental health issues were assessed for and referred to Adolescent Medicine.
Results: We have seen 67 unique patients compared to 28 with in-person visits for a similar timeframe and no-show rate dropped from 26% to 12%. Additionally, we uncovered unexpected problems or detrimental plans in 15% patients such as discontinuity of care, high-risk pregnancy, organ dysfunction or plans for life-threatening arrythmia care. Some patients revealed information, not previously disclosed to their long-standing cardiology team, which included topics of contraception, career goals, and plans for moving out of state. All educational materials were adapted from a paper-based binder and provided digitally in a more concise manner. Transition clinic was changed from Friday afternoons to Wednesday afternoons and total transition visit time was reduced from two hours to one hour.
Conclusions: In our preliminary experience, patients appear to disclose more openly when meeting virtually with unfamiliar providers than at standard clinic visits. No-show still occurred but was less frequent and less disruptive to provider schedules. The virtual approach relieved pressure on busy clinic space and designated team insured consistent coordination and communication. Additional evaluation is planned to explore the long-term impact.
Project Design: In July 2021, Transition Clinic was converted to telehealth format with a nurse leader, scheduler, and in-house cardiologist with experience in life-long course of disease and specific developmental and mental health issues of the population. Target age range was 17-21 years. The process for referral from the primary cardiologist was streamlined to capture appropriate patients. Visits focused on assessment of readiness for self-care and health literacy, education about navigating adult healthcare systems, natural history of disease, and plans for timing and destination of adult care for cardiology. Reproductive and mental health issues were assessed for and referred to Adolescent Medicine.
Results: We have seen 67 unique patients compared to 28 with in-person visits for a similar timeframe and no-show rate dropped from 26% to 12%. Additionally, we uncovered unexpected problems or detrimental plans in 15% patients such as discontinuity of care, high-risk pregnancy, organ dysfunction or plans for life-threatening arrythmia care. Some patients revealed information, not previously disclosed to their long-standing cardiology team, which included topics of contraception, career goals, and plans for moving out of state. All educational materials were adapted from a paper-based binder and provided digitally in a more concise manner. Transition clinic was changed from Friday afternoons to Wednesday afternoons and total transition visit time was reduced from two hours to one hour.
Conclusions: In our preliminary experience, patients appear to disclose more openly when meeting virtually with unfamiliar providers than at standard clinic visits. No-show still occurred but was less frequent and less disruptive to provider schedules. The virtual approach relieved pressure on busy clinic space and designated team insured consistent coordination and communication. Additional evaluation is planned to explore the long-term impact.
