JMIR Publications

ABSTRACT

Background:

In the face of hospital capacity strain, hospitals have built multifaceted plans to try to improve patient flow. Many of these initiatives have focused on the timing of discharges and lowering length of stay and have been met with variable success. We deployed a novel discharge communication tool in the electronic health record (EHR) to enhance communication around discharge.

Objective:

Evaluate the effectiveness of a discharge communication tool

Methods:

We conducted a prospective, single center, quasi-experimental, pre-post study with Hospitalist physicians and advanced practice providers to evaluate the Discharge Today Tool, an electronic health record (EHR) communication tool. We assessed adoption of the tool as well as the usability of and experience with Hospital Medicine physicians, advanced practice providers, nursing, care management, and other clinical staff during the pilot implementation period. In addition, using multivariable mixed modeling, we compared discharge order time, discharge time, and length of stay during a pre-implementation period (October 1, 2018 to March 4, 2019), the pilot implementation period (March 5, 2019 to July 31, 2019), and a post-implementation maintenance period (August 1, 2019 to December 31, 2019).

Results:

During the pilot implementation period, from March 5, 2019 to July 31, 2019, 4,707 patients were discharged (compared to 4,558 patients discharged during the pre-implementation period). Three hundred and fifty-two clinical staff had wrenched in the tool and 85% percent of patients during the pilot period had a discharge status assigned at least once. In a survey of hospital medicine providers and clinical staff, the majority of respondents reported that the tool was helpful and either saved time or did not add additional time to their workflow. 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 EHR by the discharging physician and in the time of day the patient left the hospital (decrease of 2.9 minutes per additional patient, P=0.07 and 3 minutes per additional patient, P=0.07, respectively). After adding teams staffed with an advanced practice provider (APP) 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=0.04). Finally, in adjusted analysis, hospital length of stay decreased by an average of 3.7% (P=0.06).

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 advanced practice provider (APP) or in higher census situations.