Purpose: We report progress on a recently funded AHRQ grant to develop, implement and evaluate an interactive patient-centered discharge toolkit (PDTK) that we are implementing as part of the concurrent BWH Patient Safety Learning Laboratory initiative.
Description: The PDTK (Figure 1) allows hospitalized patients to self-assess discharge preparedness from a patient portal available on mobile devices. Patients are prompted to view key elements of the discharge plan (discharge destination, follow-up appointments) and complete the pre-discharge checklist prior to the expected discharge date. Discharge-preparedness information entered by patients is then displayed on an interactive safety dashboard (integrated into the EHR) and is readily available for providers to view on rounds. Thus, providers can quickly visualize the state of discharge preparedness (red, yellow, green action indicators), identify key concerns and barriers from the patient’s perspective (unaddressed pre-discharge checklist items), and initiate corrective action. Furthermore, the PDTK integrates with secure messaging applications to notify providers when important items have not been addressed, and allows patients to communicate with their attending after discharge to address issues that arise. We are enrolling 500 patients admitted to general medicine units. Of 253 patients surveyed approximately 24-48 hours prior to discharge, only 171 (67.5%) felt prepared and 172 (68%) felt confident that their care team communicated about the discharge plan, suggesting much room for improvement.
Conclusions: The PDTK has been well received by patient advocates, administrators, and nursing and physician leadership primarily because it is well aligned with hospital initiatives related to promoting patient engagement, increasing throughput, and facilitating safety. Our planned evaluation will advance knowledge regarding the use of patient-centered technology for discharge preparation as well as the potential impact on patient activation, self-efficacy, healthcare resource utilization, and patient satisfaction.