EMR for Standardization of the Hospital Discharge Appointment Process

Background:

Discharge from the hospital is a critical transition point in patient care. This transition is a vulnerable time for patients, with many experiencing medical error and adverse events after discharge. Improving patient safety during this transition from the in‐patient to outpatient setting involves multiple processes including insuring appropriate and early follow‐up for patients at the time of discharge.

Purpose:

To develop a standardized discharge appointment process using the electronic medical record for all patients discharged from the internal medicine service.

Description:

The health care system is a university‐based hospital with several outlying clinics serving the indigent population of the city. Between 2006 and 2007, the health care system implemented the electronic medical record including order entry. In the beginning of 2007, a group of physicians, nurses, IT staff, and administration met to develop a standardized discharge process using EMR to ensure every patient discharged from the medicine wards obtained a follow‐up appointment prior to discharge. The process was implemented at the end of April 2007. The process includes the following steps: (1) physicians place consult for discharge appointment using electronic order entry; (2) the systems appointment center obtains consult electronically; (3) the appointment center makes a follow‐up appointment and places a discharge appointment note containing follow‐up date, time, and location including address and phone number in form of a letter to the patient; and (4) at the time of discharge, the nursing staff prints the discharge appointment note and gives it to the patient.

Conclusions:

Preliminary data obtained 74 days before and after implementation of the discharge process showed an increase in follow‐up appointment show rate from 35% to 50% and a slight decrease in 30‐day readmission from 14.1% to 13.5%. The initial data suggest that the electronic medical record can be used successfully in standardizing processes involved in the discharge of patients from the hospital. Further investigation of the causes of the readmissions and no shows is our next step in improving the transition of care from the inpatient to outpatient setting.

Author Disclosure:

R. Poteet, none.