Background: Follow-up services after stroke may improve functional outcome and decrease readmissions. We aimed to improve discharge of patients from the stroke service by ensuring that they have a follow up appointment with Neurology scheduled at the time of discharge, to evaluate factors impacting appointment scheduling, and to evaluate factors impacting appointment attendance.
Hypothesis: We hypothesized that access to an online scheduler would increase appointments scheduled at the time of discharge.
Methods: This retrospective analysis included patients diagnosed with ischemic stroke, TIA, intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (1/2013 - 9/2014 time) discharged from the stroke service, but excluded patients who were deceased, transferred to another inpatient facility, clinical trial patients, and those with outside providers. The following metrics were collected from 975 patient discharges: diagnosis, date of hospitalization, length of hospitalization, discharge location, time from discharge to clinic appointment, if appointment was made at the time of discharge, and if the clinic appointment was attended.
Results: Access to an online scheduling tool did not increase the number of patients who were discharged with an appointment (35% v. 41%; p=0.087). However, appointments were scheduled significantly more frequently for patients hospitalized for > 5 days, ICH and Ischemic stroke patients, and those discharged to a facility (Figure 1). Patients for whom an appointment was made prior to discharge did not follow up more frequently than those who were asked to call to make an appointment (45% v. 43%, p=0.64); however, follow up was influenced by length of stay, diagnosis, discharge location and time to appointment (Figure 2).
Conclusion: Scheduling an appointment prior to discharge did not improve post-discharge follow-up. Future directions will work to elucidate the reason for poor clinic attendance and increase follow-up.