Abstracts

Rationale: Boston Children’s Hospital cares for patients into adulthood.  Adult patients present unique challenges and obligations; including logistical and legal care provisions.  We report on a quality improvement project to increase compliance of adult documentation in our epilepsy clinic as part of a transition support effort. Our primary goal is to improve transition care through education and support of our population with the ancillary benefit of improving documentation compliance. Methods: A 6 month retrospective review of adult patients seen in our clinic was conducted, which included a review of medical records to determine presence of appropriate documentation.  We define appropriate documentation as either a release of information or guardianship (or equivalent) decrees.   We designed an algorithm, created staff and patient education materials, and modified department check-in process.  We standardized communication method for support staff to solicit documentation and designed a referral process for clinical staff to discuss transition topics.  A 6 month review was also conducted post intervention.   A review of the medical record was conducted for patient demographics that included: age, information related to the ability consent, and presence of incorrect documentation.  We define incorrect documentation as releases signed prior to age of consent, or incomplete/ inaccurate guardianship decrees or consents.  The project team included nursing, social work, and administrative staff. Results: There were 328 adult patients in the pre-intervention cohort.  159 of the 328 had correct documentation (48%.)  Of the collected documentation, 88 were legally consenting (55%) and 71 were incapacitated (45%.)   The age range was 18 – 54 years (M=36.5, median=21, mode=18.)  There were 327 adult patients in the post-intervention cohort.  199 of the 327 had correct documentation (61%.)  Of the collected documentation, 116 were legally consenting (58%) and 83 were incapacitated (42%.)  The age range was 18-55 years, (M= 36.5, median= 21, mode =18.)  Our intervention yielded a 13% increase in correct documentation 6 month post intervention.   Incorrect documentation was found in 6% of the pre-intervention cohort and 4 % of the post-intervention cohort. Conclusions: This project was meaningful as a catalyst for staff to engage in transition work.  Work included support of self-advocacy, communication, guardianship, health care proxy, and transfer to adult services.   An additional benefit was to improve compliance; as our findings show the intervention yielded an improvement in correct documentation.  Documentation error rates point to a need for further education for patient/family and staff.  Limitations include a population of international patients that may not have obtained guardianship or other decrees based on their temporary status and laws regarding guardianship/consent vary.   This initiative has been discoursed at hospital wide trainings and has prompted discussions with departments across the enterprise to adopt similar interventions.  Funding: None