The Effectiveness of a Multidisciplinary Electronic Discharge Readiness Tool: Prospective, Single-Center, Pre-Post Study

Abstract

Background In the face of hospital capacity strain, hospitals have developed multifaceted plans to try to improve patient flow. Many of these initiatives have focused on the timing of discharges and on lowering lengths of stay, and they have met with variable success. We deployed a novel tool in the electronic health record to enhance discharge communication. Objective The aim of this study is to evaluate the effectiveness of a discharge communication tool. Methods This was a prospective, single-center, pre-post study. Hospitalist physicians and advanced practice providers (APPs) used the Discharge Today Tool to update patient discharge readiness every morning and at any time the patient status changed throughout the day. Primary outcomes were tool use, time of day the clinician entered the discharge order, time of day the patient left the hospital, and hospital length of stay. We used linear mixed modeling and generalized linear mixed modeling, with team and discharging provider included in all the models to account for patients cared for by the same team and the same provider. Results During the pilot implementation period from March 5, 2019, to July 31, 2019, a total of 4707 patients were discharged (compared with 4558 patients discharged during the preimplementation period). A total of 352 clinical staff had used the tool, and 84.85% (3994/4707) of the patients during the pilot period had a discharge status assigned at least once. In a survey, most respondents reported that the tool was helpful (32/34, 94% of clinical staff) and either saved time or did not add additional time to their workflow (21/24, 88% of providers, and 34/34, 100% of clinical staff). Although improvements were not observed in either unadjusted or adjusted analyses, after including starting morning census per team as an effect modifier, there was a reduction in the time of day the discharge order was entered into the electronic health record by the discharging physician and in the time of day the patient left the hospital (decrease of 2.9 minutes per additional patient, P=.07, and 3 minutes per additional patient, P=.07, respectively). As an effect modifier, for teams that included an APP, there was a significant reduction in the time of day the patient left the hospital beyond the reduction seen for teams without an APP (decrease of 19.1 minutes per patient, P=.04). Finally, in the adjusted analysis, hospital length of stay decreased by an average of 3.7% (P=.06). Conclusions The Discharge Today tool allows for real time documentation and sharing of discharge status. Our results suggest an overall positive response by care team members and that the tool may be useful for improving discharge time and length of stay if a team is staffed with an APP or in higher-census situations.

Communicating Patient Discharge Readiness

“…Other care team members, including case managers and nursing staff, can view the primary team's assessment of patient discharge readiness in real time with the EHR. While the Discharge Today tool was designed in partnership with both hospitalist clinicians and other clinical staff, 4 and demonstrated effectiveness in a limited setting, 9 adoption has remained low. This is likely because the initial focus of the work was on designing and building the tool, rather than concurrently developing a robust implementation plan.…”

“…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 4,9. This tool, designed by a multidisciplinary team including hospitalists and information system analysts, is integrated into the electronic health record (EHR) patient worklists commonly used by clinical staff.…”

“…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. 4,9 This tool, designed by a multidisciplinary team including hospitalists and information system analysts, is integrated into the electronic health record (EHR) patient worklists commonly used by clinical staff. This tool prompts physicians and advanced practice providers (APPs) caring for hospitalized patients to document the patient's discharge readiness (definite today, possible today, tomorrow, in 24-48 hours, or in >48 hours) daily or when a patient's status changes.…”