Discharge Today: The Efficacy of a Multidisciplinary Electronic Discharge Readiness Tool

Join us as this presenter discusses this poster live on Tuesday, August 11, 2020 | Track A at 5:15 PM Mountain

PRESENTER
ANGELA KENISTON, MSPH
Director, Data and Analytics/Instructor, University of Colorado
BACKGROUND
Commonly used discharge communication workflows hinder timely and efficient discharge. Studies exploring the use of the EHR for discharge planning have been limited to electronic reports constructed from EHR data elements, including barriers to discharge documented at admission, care management data, and discharge criteria or other targeted interventions such as improving discharge summaries for patients or medication reconciliation at discharge. To address these deficits, we developed an innovative EHR tool to facilitate communication in real-time between hospitalists and other clinicians about discharge readiness and barriers to discharge.
POPULATION
All clinicians who were scheduled to be on an inpatient Hospital Medicine service were trained and asked to use the Discharge Today tool with all patients assigned to their team.
METHODS
This study is a prospective, single center, pragmatic, interrupted time series study. Clinicians were asked to update patient discharge readiness (Definite, Possible, Tomorrow, In 24-48 hours, > 48 hours) and any barriers to discharge, every morning and anytime patient status changed. Primary outcomes were time of day the clinician enters the discharge order, time of day the patient leaves the hospital, and hospital length of stay. Secondary outcomes were proportion of patients with a discharge order before 11 am and proportion of patients discharged before 11 am. We used linear mixed modeling and generalized linear mixed modeling with team and discharging provider included in all models to account for patients cared for by the same team and the same provider.
RESULTS
We found that, after adjusting for pre-specified confounders and effect modifiers, for every one patient increase in the morning census, there was a statistically significant reduction in the time of day the discharge order was entered into the EHR by the discharging physician (3 minutes per patient (95% CI: 42 seconds, 6 minutes), p=0.0245) for the pilot implementation period compared to the pre-implementation period, though not for the post-implementation period (p=0.4526). We also found a statistically significant reduction in hospital length of stay for the pilot implementation period compared to the pre-implementation period (56 minutes (95% CI: 52 minutes, 1 hour), p=0.0047), though not for the post-implementation period (p=0.4342).
CONCLUSIONS
Our Discharge Today tool is a real-time communication tool, created by hospitalists and other healthcare professionals who participate in discharge planning to not only document and communicate what tasks need to be completed before a patient can be discharged but also to help clinicians, nursing, and other staff to prioritize their work in real-time. Our analysis suggests this tool is useful for improving discharge timing, particularly as the number of patients being cared for by a team increases.
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Posted in Poster Session, Study Design & Analysis.

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