Association of Interprofessional Discharge Planning Using an Electronic Health Record Tool With Hospital Length of Stay Among Patients with Multimorbidity

Kutz, Alexander; Haubitz, Sebastian; Conca, Antoinette; Baechli, Ciril; Regez, Katharina; Gregoriano, Claudia; Ebrahimi, Fahim; Bassetti, Stefano; Eckstein, Jens; Beer, Jürg H.; Egloff, Michaël; Kaeppeli, Andrea; Ehmann, Tobias; Hoess, Claus; Schaad, Heinz J.; Wharam, J. Frank; Lieberherr, Antoine; Wagner, Ulrich; Geest, Sabina De; Schüetz, Philipp; Müeller, Beat

doi:10.1001/jamanetworkopen.2022.33667

Cited by 5 publications

(4 citation statements)

References 39 publications

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“…The cornerstones of the Brigham progression framework are based on interdisciplinary communication, engagement, and data capture (Kutz et al, 2022; Meo at al., 2020; Rojas-García et al, 2018). In creating processes to facilitate communication and ease documentation burden, data can be leveraged to identify progression status and barriers at the patient and system level.…”

Section: Findings and Discussionmentioning

confidence: 99%

Optimization of Patient Progression in a New Era

Smith,

Escobar,

McCabe

et al. 2024

Professional Case Management

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Purpose/Objectives: The onset of the coronavirus disease 2019 pandemic increased the demand for inpatient services and led to widespread staffing shortages in the acute and post-acute setting, contributing to delayed inpatient throughput and leading to capacity crises. Novel strategies are needed to facilitate the efficient progression of hospitalized patients when medically ready for lower levels of care. The authors have developed a foundational strategic framework for patient progression to ensure capture of patient progression data, enhance efficiency, and optimal utilization of post-acute resources in increasingly complex and resource-constrained acute and post-acute environments. Primary Practice Setting(s): Interventions were implemented, and metrics of success tracked as part of an overarching framework to test new models of care or optimize existing assets related to barriers to patient progression. Brigham and Women's Hospital (BWH) and Brigham and Women's Faulkner Hospital (BWFH) comprise an academic medical center and a community hospital, respectively, that are affiliated with Massachusetts General Brigham (MGB), a nonprofit health care system in Massachusetts. Key interventions include (1) screening to prioritize patients needing case management services through a modified early screening for discharge planning tool and process; (2) communicating, documenting, identifying patient progression status, barriers to discharge and post-acute needs through interdisciplinary care optimization rounds, a novel tool in the electronic health record, and an associated dashboard; (3) managing active high-risk patients through a novel complex care team and post-acute strategy development; (4) developing novel transportation and hospice pathways; and (5) establishing community hospital repatriation and a physical therapy “Why Not Home” campaign. Findings: Key metrics of success were (1) modified discharge planning tool resulting in screening out low-risk patients (53%) and impacting length of stay (0.55-day reduction, p = .083) during a 3-month intervention versus control study; (2) documentation adherence in more than 98% of patients 10 months postimplementation; (3) complex care team achieving a 2.5% reduction in Case Mix Index-adjusted length of stay 6 months postimplementation; (4) use of care van offsetting ambulance/chair car in 10% of cases, and earlier discharge time/length of stay in 21% of cases 3 months postimplementation; and (5) implementation of community repatriation impacting delay days to discharge (10-month pilot, 40 patients accounting for 1,000 delay days). Conclusions: Implementation of a novel comprehensive framework focusing on optimizing patient progression resulted in increased operational efficiency and positively impacted length of stay at our academic and community hospitals. Additional study is actively ongoing to understand long-term benefit of the innovations that the authors have developed. Further interventions are needed to wholly mitigate evolving capacity challenges in the acute and post-acute settings. Implications for Case Management Practice: The authors' implementation of the Brigham framework for progression demonstrates that innovative approaches to case management can help address the evolving challenges in care transitions planning. Notable opportunities include approaches that empower case managers as multidisciplinary team leaders, improve workflow, utilize patient progression data, prioritize patients with complex care needs support key patient populations, and promote post-acute collaboration.

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Section: Findings and Discussionmentioning

confidence: 99%

Optimization of Patient Progression in a New Era

Smith,

Escobar,

McCabe

et al. 2024

Professional Case Management

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“…A multicenter clustered clinical study involving patients with multimorbidity hospitalized at 82 hospitals in Switzerland evaluated the effectiveness of a hospital discharge planning tool embedded in the electronic medical records in comparison with standard discharge procedures on reducing hospital length of stay. 1 The authors analyzed the results of an interrupted time series of acute medical hospitalizations. They reported that the planning tool vs. standard procedures reduced the length of hospital stay (−0.879 h/month; 95% CI, −1.607 to −0.150 h/month vs. −0.011/month; 95% CI, −0.281 to 0.260 h/month), with no increase in hospital readmissions, in-hospital mortality, or facility discharge.…”

Section: Practical Scenariomentioning

confidence: 99%

Mixed-effects model: a useful statistical tool for longitudinal and cluster studies

2023

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“…staff to discharge patients quickly and safely from the hospital. Health information technology (HIT) solutions can help solve patient flow problems, including identifying criteria for discharging patients when they are clinically ready to discharge, [1][2][3] coordinating and communicating about patient discharge readiness, [4][5][6] and helping make informed decisions about capacity allowing real-time capacity management. 7,8 We piloted a Discharge Today tool designed to facilitate real-time communication across clinicians and health care staff about patient discharge readiness with the goal of improving the efficiency of patient discharge.…”

mentioning

confidence: 99%

“…The progression of patients through a hospital from admission to discharge (ie, patient flow) can be slowed by delays in patient discharge, increasing pressure on health care staff to discharge patients quickly and safely from the hospital. Health information technology (HIT) solutions can help solve patient flow problems, including identifying criteria for discharging patients when they are clinically ready to discharge,1-3 coordinating and communicating about patient discharge readiness,4-6 and helping make informed decisions about capacity allowing real-time capacity management 7,8…”

mentioning

confidence: 99%

Communicating Patient Discharge Readiness

Keniston,

McCreight,

Burden

et al. 2023

Journal of Nursing Care Quality

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Background: The progression of patients through a hospital from admission to discharge can be slowed by delays in patient discharge, increasing pressure on health care staff. We designed and piloted the Discharge Today tool, with the goal of improving the efficiency of patient discharge; however, adoption remained low. Purpose: To close this implementation gap, we deployed and evaluated a 4-part implementation strategy bundle. Methods: We measured the success of implementation by evaluating validated implementation outcomes using both quantitative and qualitative methods, grounded in Normalization Process Theory. Results: The implementation strategies used were effective for increasing use of the Discharge Today tool by hospital medicine physicians and advanced practice providers during both the active and passive implementation periods. Conclusions: While the implementation strategies used were effective, qualitative findings indicate that limitations in the functionality of the tool, alongside inconsistent use of the tool across clinical staff, continued to inhibit adoption.

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Association of Interprofessional Discharge Planning Using an Electronic Health Record Tool With Hospital Length of Stay Among Patients with Multimorbidity

Cited by 5 publications

References 39 publications

Optimization of Patient Progression in a New Era

Optimization of Patient Progression in a New Era

Mixed-effects model: a useful statistical tool for longitudinal and cluster studies

Communicating Patient Discharge Readiness

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