Background: Reducing hospital length of stay (LOS) for patients who are medically ready for discharge is both an operational necessity and a shared patient goal given fixed hospital capacities and rising costs of care. Presently, there is no readily identifiable time-point in the electronic medical record (EMR) denoting when patients become medically ready for discharge. Therefore, it is challenging to ensure real-time escalation of barriers and long-term tracking of delayed patient discharges for quality improvement purposes and LOS interventions.
Purpose: We created an “Awaiting Safe Discharge” EMR tracking tool to mark real-time medical readiness for discharge. We integrated the tool into an escalation system during multidisciplinary and discharge barrier escalation rounds. Our tool facilitates real-time barrier escalation and prospective tracking of data surrounding patients who remain hospitalized despite being medically ready for discharge.
Description: Our definition of a patient who is “Awaiting Safe Discharge” is one who is medically ready for discharge but remains hospitalized due to a variety of barriers and post-acute care needs some of which include: awaiting rehab facility placement, ongoing guardianship process discussion, insurance-related delays, complex post-acute needs for dialysis/IV antibiotics, homelessness, etc.The “Awaiting Safe Discharge” tool was created in Epic EMR under the Admission, Transfer, and Discharge tabs. It is a checkbox with Yes/No options and optional notes. The tool is accessible by any physician, provider, case manager, or social worker involved in the patient’s care. It is meant to be clicked for every patient during multidisciplinary rounds as appropriate. Upon selecting “Yes”, the patient is populated into a templated “Multidisciplinary Patient List” for each multidisciplinary rounds thus helping to tailor discussion surrounding the patient’s discharge needs. Patients who are identified as medically ready are also highlighted in twice weekly barrier meetings with Care Coordination leadership. We track utilization by team and role, and follow the outcome of proportion of patient days in awaiting safe discharge status and by ultimate disposition. The field is used to facilitate reporting of the number and reasons of delayed discharge patient days for operational awareness and targeted interventions aimed at reducing LOS.
Conclusions: An “Awaiting Safe Discharge” EMR tracking tool can help stakeholders and managers to identify patients who are medically ready for discharge in real time and potentally reduce patient LOS while helping to focus resource allocation for tackling of barriers and strategic post-acute partnerships.