Background/Purpose: Effective communication is essential in caring for medically complex patients with rheumatologic diseases. In our prior study of rheumatoid arthritis patients and hospital admissions, our rheumatologists were only notified 57.6% of the time. This project’s goal was to integrate an auto-notification system into our clinical workflow, so that timely communication of sentinel events (Elective surgery, Hospital admission, or ER visit) in immunosuppressed rheumatic disease patients happens by design, not by accident.

Methods: We developed an algorithm that triggers an auto-notification to the Rheumatology Nurse Navigator when a patient of interest (POI) experiences a sentinel event. A POI has been seen by a rheumatologist at least twice within the past 14 months and takes a DMARD or glucocorticoid. The Nurse Navigator creates a telephone encounter that includes the event type, baseline glucocorticoid and DMARD therapy, and event date. That encounter is forwarded to the rheumatologist, who records recommendations based on current guidelines and returns it to the Nurse Navigator, who notifies the patient or other providers of the recommendations.

Results: During the four-month study period, 240 completed notifications were received – 57% for elective surgeries, 39% for ER visits, and 4% for admissions. The need for change in care plan was less common for ER visits (17%), but was 25% for hospital admissions and 44% for elective surgeries. A significant result is the time interval between receipt of the notification and the date of elective surgery. This is applicable to our patients taking biologic DMARDs and/or high dose glucocorticoids, as these medications may require holding or adjusting a dose weeks before surgery. The mean number of days in this interval was 23. Therefore, this notification process is useful in the case of medications that need to be held or adjusted three weeks or less prior to surgery. The time commitment by clinicians has been minimal. The nurse spent an average of 5 minutes for each patient and the physicians spent an average of 5.9 minutes. The percentage of time that clinicians were notified of sentinel events increased from 57.6% to 100%.

Conclusion: Without knowledge of the care team, and no communication process integrated into the clinical workflow, communication and care handoff failures are extremely common. We developed a process that “hardwires” notification of the specialist for a patient sentinel event, to facilitate timely and relevant care. The average number of messages that clinicians received per week was 2.2. Since the average number of minutes clinicians spent per message was 5.9, this resulted in only 13 minutes of work for each clinician per week, making this a very manageable process.  With this automated program, care communication failures fell from 42.4% to 0%. As changes to the care plan were needed 34% of the time, this notification is crucial to our patient care. The process is easy, reliable, and has been well-received. As the program has been effective in improving patient care and outcomes, other divisions in our institution, such as Pulmonary, are developing a similar program for their patient population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/use-of-a-novel-electronic-auto-notification-process-to-manage-transitions-of-care-in-rheumatic-patients-on-dmard-therapy/