JMIR Publications

ABSTRACT

Background:

Poor discharge preparation during hospitalization may lead to adverse events after discharge. Checklists and videos that systematically engage patients in preparing for a discharge have potential to improve safety, especially when integrated into clinician workflow via the electronic health record (EHR).

Objective:

To evaluate the implementation of a suite of digital health tools integrated with the EHR to engage hospitalized patients, caregivers, and their care team in preparing for discharge.

Methods:

We iteratively refined patient and clinician-facing intervention components using a participatory process involving end-users and institutional stakeholders. As part of the intervention, patients were coached to watch a discharge preparation video, complete a discharge checklist, and request post-discharge text messaging with a physician 24-48 hours prior to their expected discharge date displayed via a patient portal and bedside display. Clinicians could view concerns reported by patients based on their checklist responses in real-time on a safety dashboard integrated with the EHR and choose to open a secure messaging thread with the patient for up to 7-days after discharge. We used mixed methods to evaluate our implementation experience.

Results:

Of 752 patient-admissions, 510 (67.8%) patients or caregivers participated: 416 (55.3%) watched the video and completed the checklist, and 94 (12.5%) completed the checklist alone. On average, 4.24 concerns were reported per checklist submission, most commonly about medications (30.7%) and follow-up (30.3%). Of the 510 patient-admissions, a member of the care team accessed the safety dashboard to view patient-reported concerns in 210 (41.2%). For 422 patient-admissions where post-discharge messaging was available, 141 (33.4%) patients requested this service; of these, a physician initiated secure messaging for 3 (2.1%) discharges. Most patient survey participants perceived that the intervention promoted self-management and communication with their care team. Patient interview participants endorsed gaps in communication with their care team and thought that the video and checklist would be useful closer towards discharge. Clinicians participating in focus groups perceived value for patients but suggested that low awareness and variable workflow regarding the intervention, lack of technical optimization, and inconsistent leadership limited use of clinician-facing components.

Conclusions:

We offer strategies to address implementation barriers and promote adoption of EHR-integrated digital health tools to engage patients, caregivers, and clinicians in discharge preparation during hospitalization to facilitate a safe transition home. Clinical Trial: ClinicalTrials.gov NCT03116074