Firing Up the Patient Discharge Process

Purpose:
The patient discharge process was fragmented, paper-based and at times illegible contributing to workflow inefficiencies for the discharging nurse. This EHR upgrade goal was to enable significant and measurable improvements in patient health through a transformed health care delivery system.

Significance:
The importance of creating an individualized discharge plan of care supplies critical information to patients in a legible fashion to better manage their wellness. Provider's now have real-time access to information and tools to ensure the quality and safety of care provided to patients.

Strategy and Implementation:
The EHR Team worked with a vendor to review available solutions for the electronic discharge process. The team then worked with end-users and conducted individualized workflow sessions with disciplines (dietary, respiratory, social work, etc.) to determine current state workflow and future state workflow. After completion of the sessions IS was provided with specifications to build the discharge process based on workflow and identified needs. Participants then tested the build against the established future state workflow. A train the trainer approach was used to conduct sessions for all end users for all disciplines. Validation of learning was conducted by a team of super users. The clinical transformation team worked with all users to reinforce knowledge and understanding of the future state, including communication via newsletters, posters, email, meetings, and an open house for practice. End-users were actively involved throughout the process with implementation completed June 1.

Evaluation:
One measure of effectiveness is discharge medication reconciliation compliance that has improved from 65% (preupdate) to 82% (10 days post update), providing patients with a comprehensive start, stop, continue legible, literacy based medication list.

Implications for Practice:
Implications for practice are numerous, including nurses providing patients with a comprehensive, literacy based discharge plan of care that is legible and easily communicated to the next provider of care.