Project Boost: Identifying Barriers to the Discharge Process

Background:

Transition Irom hospital to home is a vulnerable time for the frail elderly, and the complex discharge process benefits from a multidisci‐plinary approach and care coordination. Asuboplimel discharge process may lead to dissatisfaction, early readmission, and poor outcomes. Project BOOST (Better Outcomes for Older Adults Ihrough Safe Transitions} is a mentored project with the Society of Hospital Medicine that aims lo improve the discharge process, reduce readmissions, and improve patient satisfaction, especially when the hospital team may not follow the patient in the outpatient setting.

Purpose:

Identify barriers in our hospital setting to optimize the discharge process.

Description:

This project was piloted on the Acute Care for Elders Unit (ACE) at Aurora Sinai Medical Center in Milwaukee, Wisconsin. This unit solely cares for patients age 64 years and older regardless of admitting diagnosis. A multidisciplinary team composed of representatives from hospital administration, nurses, pharmacy, doctors, social services, and the quality department was formed as the initial step. One of their recommendations was lo use the 7Ps” [Problem medications. Punk (depression), Principal diagnoses, Polypharmacy, Poor health literacy, Patient support, and Prior hospitalization] guidelines from Project Boost to perform a chart review to identify measurable outcomes. The team also suggested development of a flow chart documenting current activities and the ideal state. The primary care physician (PCP) was noted in the discharge summary (55%), Ihe summary was transmitted To the PCP 73% of the time, and the patient was seen in clinic 73% of Ihe time. Twenty percent of patients received follow‐up calls within 72 hours. Development of the current stale flow chart identified a number of issues including lime and funding as major constraints faced by key personnel, communication across and within the organization, difficulty accessing relevant information in the electronic medical record, and duplication of efforts occurs at multiple levels.

Conclusions:

This is the first time in our hospital that a dedicated multidisciplinary team identified barriers lo the discharge process. We recognized that transitions in care are complex and it is best to optimize the efforts of the team. The electronic medical record can be leveraged to identify vulnerable elderly patients and to provide appropriate interventions and feedback at the team level.

Author Disclosure:

A. Khan, AUWMG. NA.