Improving Patient Portal Activation for Newborns in the Well Baby Nursery.

BACKGROUND: Patient portals provide parents access to their child's health information and direct communication with providers. Our study aimed to improve portal activation rates of newborns during nursery hospitalization to >70% over 6 months. Secondarily, we describe the facilitators and barriers to portal use. METHODS: The study design used a mixed-methodology framework of quality improvement (QI) and cross-sectional analyses. The Model for Improvement guided QI efforts. The primary outcome was the proportion of portals activated for newborns during nursery hospitalization. Interventions included portal activation algorithm, staff huddles, and documentation templates. Telephone interviews were conducted with a randomized sample of mothers of infants who activated the portal. These mothers were divided into portal "users" and "nonusers." We examined sociodemographic variables and health care utilization outcomes in the 2 groups. RESULTS: Portal activation increased from 12.9% to 85.4% after interventions. Among 482 mothers with active portals, 127 (26.3%) were interviewed. Of those, 70% (89 of 127) reported using the portal, and 85.4% (76 of 89) found it useful. Reasons for accessing the portal included checking appointments and reviewing test results. Lack of knowledge of portal functionality was the main barrier to portal use (42.1%). Portal users were less likely to have a no-show to primary care appointments compared with nonusers (44.9% versus 78.9%, P < .001). CONCLUSIONS: Portal activation rates increased after QI interventions in the nursery. Most parents accessed the portal and found it useful. Portals can improve health care delivery and patient engagement in the newborn period.

A Quality Improvement Project to Improve Hospital-to-Home Transitions Using Discharge Televisits.

BACKGROUND: Resident-led discharge "televisits" can improve the safety of hospital-to-home transitions by increasing completed follow-up and providing patients access to their inpatient providers to troubleshoot issues. METHODS: This single-center quality improvement study was set in a pediatric unit within an academically affiliated public safety-net hospital. By August 2021, the aim was to use resident-led phone call televisits within 72 hours of discharge to increase completed follow-up from 67% to 85% among patients discharged from the general pediatric unit and compare this to patients scheduled for in person visits. Patients were preferentially scheduled for televisits based on investigator-defined criteria to maximize benefit (eg, prescribed new medications). The process measure was the proportion of televisit slots filled. The balancing measures were 7-day emergency department visits and readmissions. Topics addressed during televisits were categorized to qualitatively assess potential benefits. RESULTS: Three hundred and fifteen (44.5%) patients had televisits, 234 (33.1%) in person visits, and 159 (22.5%) unconfirmed follow-up. The available televisit appointments scheduled were 315 of 434 (72.5%). Completed follow-up was 88.3% for televisits and 63.3% for in person visits, compared with 67% during the baseline period. Completed follow-up was 4.4 (95% confidence interval 2.9 to 6.8) times more likely for televisits compared with in person visits after controlling for confounding variables. Common topics addressed during televisits were test results, medication issues, and appointment issues. Emergency department revisits and readmissions were similar between groups. CONCLUSIONS: Resident-led discharge televisits are an innovative way to increase completeness of discharge follow-up.