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Hospital Discharge Appointment Scheduling

We are trying to improve patient continuity of care and transitions from hospital to clinic by informing patients of their follow-up appointments prior to discharge whenever possible. Discuss who on the team will be primary neurologist going forward (junior resident, senior resident, attending). Providers who already know the patient should maintain “ownership” for continuity. They can be scheduled for a quick hospital follow-up with another provider if primary not available, and then follow-up with primary for future appointments. You can set up both the hospital follow-up and the appointment in a couple months at the same time.

  1. Send EPIC message to “Neurology Clinic All Staff”; this is a pooled mailbox that Johnathan and Javonia will be checking throughout the day.

    1. Open staff message, click on “TO…” button and type in “neurology” under “Pools” section. 

    2. Under the subject line in the message, make sure to select the patient to link the message to the chart.

    3. There is a smartphrase that will cue you for the required information: .UMHNEUROAPPREQUEST  (you can delete sections that are not relevant).

  2. Or call them at: 410-328-6483

  3. For patients going home: schedule rapid hospital follow-up AND follow-up with primary neurologist who will continue to follow longer term if appropriate

    1. Rapid hospital follow-up appointments: The goal of this appointment is to prevent readmissions to the hospital.  You should make sure that patients understood discharge instructions and discharge medication list and have been able to obtain meds and arrange for other follow-up appointments if needed.  Patients should then subsequently follow-up with their Primary Neurologist.

    2. For stroke patients going home, they can have a “Rapid Stroke” appointment with Karen Yarbrough, NP if their primary neurologist is not available and then follow-up with primary neurologist (this is one of the options in the appointment request template).

  4. For patients going to rehab: request follow-up in a couple months with primary neurologist

Last Updated: June 19, 2019