Background: Delivering high quality and efficient care is a top priority at our 800-bed quaternary care hospital. We have seen significant improvements in many patient-care domains by implementing hospital-wide standardized interdisciplinary rounds. As part of our ongoing efforts to further improve efficiency and value, we hope to leverage a simple order in our electronic medical record to communicate with all disciplines a patient’s discharge readiness 1 to 2 days in advance.
Purpose: To reduce communication barriers, automate processes, and align multiple disciplines to disposition plans, we implemented the use of an easily visible order in the electronic medical record called “Prepare for Discharge.”
Description: In the first phase of this innovative process, we asked all unit-level physician leaders to place a “Prepare for Discharge” order during interdisciplinary rounds for any patient projected to be medically ready for discharge in 1 to 2 days. We tethered the presence of this order with the testing escalation pathway (used to expedite various tests and procedures). This step encouraged more providers to utilize the new order. In phase two, once we achieved 40% compliance, we began using the order as a trigger to automate multiple steps of detailed discharge planning. These include expediting all imaging, physical therapy, PharmD medication education, setting up follow up appointments, consultant discharge recommendations, and nursing scripting to elicit concerns from patients and families and assess their understanding of discharge plans. To date, we are seeing more organic growth in the use of the “Prepare for Discharge” order due to its utility in the discharge process. Currently 70% of patients have the order placed approximately 44 hours prior to their leave. A dashboard is being developed to study individual provider utilization rates (used to give targeted feedback and education) and to monitor throughput metrics.
Conclusions: We leveraged an EMR order to trigger detailed and wide-ranging discharge planning across multiple disciplines. Given the recency of the initiative, we are still collecting data; however, since many of the above processes went live in the month of October 2022, we have seen a net excess day reduction of 0.37 from the same month last year (inclusive of all medicine patients, excluding COVID-19 cases). Additionally, providers have expressed that such an effortless ability to expedite the remainder of care as well as enhanced communication between team members and patients has improved their clinical efficiency. We expect these efforts will result in optimal hospital throughput and improved patient satisfaction scores.