Background: The EMR does not provide readily available information that conveys an at-a-glance understanding of discharge progress for a given patient. Healthcare workers have different workflows and need to manage the information in different ways, with a reliance on one-to-one conversations. We believe that optimizing patient length of stay is hindered by lack of: data shared understanding, role clarity, standardized communication models, and tools for communicating about discharge progress.
Purpose: To test our hypothesis, we developed and deployed an EMR discharge tool that: non-intrusively collects discharge data; readily displays discharge progress, tasks, and barriers; communicate data throughout the inpatient environment with optimization of delivery method and timing for different roles; allows undocumented comments that facilitate discharge; and provides these data on desktop and mobile. The purpose of the intervention is to: enable all care teams to work towards the same discharge date goal and plan; increase visibility and awareness of the anticipated or planned discharge date across all care team members, such that every team is aware of patients that are anticipated or planned for discharge either today or tomorrow during pre-rounding prep and rounds to avoid “misses”; increase visibility to possible discharge barriers (such as SNF placement issues with SW, or clearance issues with consulting services); make it easier to access discharge notes that are “buried” in daily progress or consultation notes; and ensure that the same discharge information is available throughout a patient’s chart, to eliminate “source of truth” issues.
Description: This was a prospective pragmatic study conducted over a 180-day period following deployment of the EMR discharge tool at a level 1 trauma center. All patients discharged under the care of 5 inpatient internal medicine teams at this teaching hospital and tertiary referral center were included. The primary outcome measures are percent of discharges before 12:01 p.m., length of stay, and readmission rate. We first conducted observational work to characterize the discharge processes and data already in place. Next, we held a series of semi-structured interviews with providers to identify basic discharge targets and barriers, as well as characteristics of a desired EMR discharge tool. In addition, we conducted a provider survey to identify knowledge, attitudes, and behaviors regarding the role of communication and the EMR in the discharge process. We then worked with key stakeholders including physicians, pharmacists, nurses, and discharge facilitators to deploy the discharge tool and conduct the intervention. Relevant patient demographic and clinical characteristics will be discussed. Preliminary data including the primary outcome measures as well as confounding variables will be discussed. In addition, critical considerations for the design, deployment and adoption of technology enhancements to improve transitions of care will be discussed to include components of prior successful programs as well as lessons learned from the current intervention.
Conclusions: A multidisciplinary design process may be beneficial to define the key processes, people, and features to enhance EMR support for discharge and improve discharges before 12:01pm and length of stay. Future work will deploy this tool to other medical units and measure the impact using both quantitative and qualitative data.
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