Background: Understanding patient readiness for discharge requires communication between the many disciplines who care for patients. Team members use different tools in the electronic health record (EHR) to document and communicate discharge-related information, which can result in inefficient communication, delays in discharge, and adverse patient outcomes. EHR-based discharge coordination tools have potential to improve discharge communication, care team experience, patient experience, and patient outcomes, but may suffer from poor adoption once built. We aimed to evaluate the use of one such tool and report on clinician perceptions of its utility in promoting effective discharge coordination in hospital medicine.

Methods: In April 2021, our health system developed the “Discharge Report”, an EHR-based discharge coordination tool designed to consolidate discharge planning information into a single, accessible location for asynchronous discharge communication across the interdisciplinary care team. It was designed for all disciplines as a single source of truth for discharge-relevant information, including estimated discharge date, physical and occupational therapy recommendations, case management notes, post-discharge orders, discharge medications, and upcoming appointments.  To promote the use of the tool, hospitalists have access to a best-practice guide, receive updates and tips on its use at staff meetings, and receive reminders to use the tool before starting on service. To assess hospitalist use of the Discharge Report and its impact on their discharge coordination experience, we queried EHR audit-log data of 164 hospitalists over a 3-month period and sent Qualtrics-based surveys to 160 hospital medicine attending physicians ~18 months after implementation of the Discharge Report in our EHR.

Results: According to EHR audit-logs of 164 physicians who attended on a hospital medicine primary service from July 16, 2022 to October 15, 2022, 32.3% (53) viewed the Discharge Report at least once. The 53 hospitalists who viewed the discharge report at least once logged-in to the EHR an average of 36.4 days (SD 16.3) during the study period (Figure 1). On average, these physicians viewed the Discharge Report 1 day out of every 9 days logged in to the EHR. Of 160 physicians to whom the survey was sent, 31.3% (50) completed the survey. Of the 50 who completed the survey, 42% (21) reported ever using the Discharge Report, 36% (18) knew of but had never used the Discharge Report, and 22% (11) were unfamiliar with the Discharge Report. Of the 21 physicians who had used the Discharge Report, 24% (5) regularly used the Discharge Report and reported improved workflow efficiency, 24% (5) rarely used the Discharge Report and reported no impact on workflow, and 52% (11) sometimes used the Discharge Report and reported either improved or no impact on workflow efficiency (Figure 2).

Conclusions: Fewer than half of hospital medicine attendings audited and surveyed used the Discharge Report. Regular users of the tool reported improvements in discharge workflow efficiency, while rare users of the Discharge Report reported no impact on workflow. EHR-based discharge coordination tools have the potential to improve discharge communication and workflow. However, these benefits are limited by lack of user awareness and uptake and may be user-dependent. Additional stakeholder input and user testing should guide investment in EHR-based tools to improve discharge coordination.

IMAGE 1: Figure 1. Average Days Logged into EHR and Discharge Report Viewed among Hospital Medicine Attending Physicians who Viewed the Discharge Report at Least Once from July 16, 2022 to August 15, 2022 (n=53)

IMAGE 2: Figure 2. Impact of Discharge Report on Workflow among Hospital Medicine Attending Physicians who ever Used the Discharge Report (n=21)