Background: The period immediately following discharge from a hospital admission is a vulnerable time for patients. Preventable adverse outcomes occur here for various reasons: discontinuity between hospitalists and primary care physicians, changes to medication regimens, and complex discharge instructions [1]. Many of these precipitating factors can be avoided by effective exchange of health information and greater patient engagement. Electronic patient portals provide the opportunity to address these challenges – patients can view their health records, communicate with care teams, schedule appointments, participate in telemedicine, and view their current medications. Additionally, patient portals can promote patient engagement [2], improve patient satisfaction [3-5], and ensure smooth continuity of care by allowing patients to share discharge instructions with receiving providers. Despite these benefits, 6 months of inpatient data at our institution showed only 9% of patients without an electronic patient portal upon admission were enrolled during their hospital stay. Implementation of a standardized process to increase enrollment in patient portals has the potential to improve low enrollment rates and prevent adverse events in the post-discharge period.
Purpose: To implement a standardized patient portal enrollment process that will increase the in-hospital enrollment rate, with the ultimate goal of reducing preventable adverse events in the post-discharge period.
Description: In July 2021, we conducted forty patient interviews at a 679-bed urban academic hospital to better characterize barriers to enrollment in an electronic patient portal. Lack of awareness, patient inaccessibility (e.g., occupied with the care team, asleep, altered mental state, etc.), and insufficient motivation were identified as major barriers. The following interventions were implemented to address these barriers and increase adoption: i) delivering enrollment instructions to patient rooms [5% (n=22)] ii) engaging patients at the bedside [0% (n=16)] and iii) engaging with patients in the discharge lounge [67% (n=9)]. A success was defined as a patient enrolling in the patient portal within two weeks of our intervention. The process we implemented to engage patients at the bedside and within the discharge lounge is further detailed in Figure 1.
Conclusions: Our results show that implementing a standardized process for patient portal enrollment is effective when done at the appropriate stage and setting of the patient’s hospital stay. We hypothesize the discharge lounge represents the appropriate stage and setting for patients to recognize the benefits of a patient portal as they are accessible, free from the distractions of their hospital room, and actively facing discharge from the hospital. With a 67% enrollment rate in the discharge lounge, the projected annual increase of in-hospital enrollments improves from 9% to 13% – a relative increase of 45%. As we continue our intervention to increase sample size, more patients utilizing the discharge lounge represents further opportunity for increased patient portal enrollment. To capture more patients, we plan to increase the number of patients entering the discharge lounge by educating hospital staff of its benefits and encouraging them to utilize this space for all eligible patients. We will also explore other methods of engaging patients to enroll in and interact with the patient portal to improve post-hospital discharge outcomes.
