Earlier Hospital Discharge With Prospectively Designated Discharge Time in the Electronic Health Record

Hospital discharge requires multidisciplinary coordination. Insufficient coordination impacts patient flow, resource use, and postdischarge outcomes. Our objectives were to (1) implement a prospective, multidisciplinary discharge timing designation in the electronic health record (EHR) and (2) evalu...

Full description

Saved in:
Bibliographic Details
Published in:Pediatrics (Evanston) 2019-11, Vol.144 (5), p.e20190929
Main Authors: Sklansky, Daniel J, Butteris, Sabrina, Shadman, Kristin A, Kelly, Michelle M, Edmonson, M Bruce, Nackers, Kirstin, Allen, Ann, Barreda, Christina B, Ehlenbach, Mary L, Webber, Sarah A, Tiedt, Kristin, Smith, Windy, Hoffman, Robert J, Zhao, Qianqian, Thurber, Anne S, Coller, Ryan J
Format: Article
Language:English
Subjects:
Demographics
Demography
Electronic Health Records
Electronic medical records
Hospitals, Pediatric - organization & administration
Humans
Length of Stay
Organizational Case Studies
Patient Discharge - standards
Patients
Pediatrics
Process control
Process controls
Quality Improvement
Replication
Statistical process control
Time Factors
Wisconsin
Citations: Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Hospital discharge requires multidisciplinary coordination. Insufficient coordination impacts patient flow, resource use, and postdischarge outcomes. Our objectives were to (1) implement a prospective, multidisciplinary discharge timing designation in the electronic health record (EHR) and (2) evaluate its association with discharge timing. This quality-improvement study evaluated the implementation of confirmed discharge time (CDT), an EHR designation representing specific discharge timing developed jointly by a patient's family and the health care team. CDT was intended to support task management and coordination of multidisciplinary discharge processes and could be entered and viewed by all team members. Four plan-do-study-act improvement phases were studied: (1) baseline, (2) provider education, (3) provider feedback, and (4) EHR modification. Statistical process control charts tracked CDT use and the proportion of discharges before noon. Length of stay was used as a balancing measure. During the study period from April 2013 through March 2017, 20 133 pediatric discharges occurred, with similar demographics observed throughout all phases. Mean CDT use increased from 0% to 62%, with special cause variations being detected after the provider education and EHR modification phases. Over the course of the study, the proportion of discharges before noon increased by 6.2 percentage points, from 19.9% to 26.1%, whereas length of stay decreased from 47 (interquartile range: 25-95) to 43 (interquartile range: 24-88) hours (both < .001). The implementation of a prospective, multidisciplinary EHR discharge time designation was associated with more before-noon discharges. Next steps include replicating results in other settings and determining populations that are most responsive to discharge coordination efforts.
ISSN:0031-4005
1098-4275
DOI:10.1542/peds.2019-0929