Whitney Chadwick1,2,3, Hannah Bassett4, Sarah Hendrickson5, Kimberly Slonaker6, Shanna Perales2, Julie Pantaleoni4, Nivedita Srinivas4,7, Terry Platchek4,3,8, Lauren Destino4,3. 1. Divisions of Pediatric Hospital Medicine and wchadwic@stanford.edu. 2. Departments of Clinical Informatics and. 3. Performance Improvement, Stanford Children's Health, Palo Alto, California. 4. Divisions of Pediatric Hospital Medicine and. 5. Massachusetts General Hospital for Children and Harvard Medical School, Harvard University, Boston, Massachusetts; and. 6. Department of Pediatrics, Kaiser Permanente Northern California, Santa Clara, California. 7. Pediatric Infectious Disease, School of Medicine, and. 8. Clinical Excellence Research Center, Stanford University, Stanford, California.
Abstract
OBJECTIVES: The purpose of hospital discharge instructions (HDIs) is to facilitate safe patient transitions home, but electronic health records can generate lengthy documents filled with irrelevant information. When our institution changed electronic health records, a cumbersome electronic discharge workflow produced low-value HDI and contributed to a spike in discharge delays. Our aim was to decrease these delays while improving family and provider satisfaction with HDI. METHODS: We used quality improvement methodology to redesign the electronic discharge navigator and HDI to address the following issues: (1) difficulty preparing discharge instructions before time of discharge, (2) suboptimal formatting of HDI, (3) lack of standard templates and language within HDI, and (4) difficulties translating HDI into non-English languages. Discharge delays due to HDI were tracked before and after the launch of our new discharge workflow. Parents and providers evaluated HDI and the electronic discharge workflow, respectively, before and after our intervention. Providers audited HDI for content. RESULTS: Discharge delays due to HDI errors decreased from a mean of 3.4 to 0.5 per month after our intervention. Parents' ratings of how understandable our HDIs were improved from 2.35 to 2.74 postintervention (P = .05). Pediatric resident agreement that the electronic discharge process was easy to use increased from 9% to 67% after the intervention (P < .001). CONCLUSIONS: Through multidisciplinary collaboration we facilitated advance preparation of more standardized HDI and decreased related discharge delays from the acute care units at a large tertiary care hospital.
OBJECTIVES: The purpose of hospital discharge instructions (HDIs) is to facilitate safe patient transitions home, but electronic health records can generate lengthy documents filled with irrelevant information. When our institution changed electronic health records, a cumbersome electronic discharge workflow produced low-value HDI and contributed to a spike in discharge delays. Our aim was to decrease these delays while improving family and provider satisfaction with HDI. METHODS: We used quality improvement methodology to redesign the electronic discharge navigator and HDI to address the following issues: (1) difficulty preparing discharge instructions before time of discharge, (2) suboptimal formatting of HDI, (3) lack of standard templates and language within HDI, and (4) difficulties translating HDI into non-English languages. Discharge delays due to HDI were tracked before and after the launch of our new discharge workflow. Parents and providers evaluated HDI and the electronic discharge workflow, respectively, before and after our intervention. Providers audited HDI for content. RESULTS: Discharge delays due to HDI errors decreased from a mean of 3.4 to 0.5 per month after our intervention. Parents' ratings of how understandable our HDIs were improved from 2.35 to 2.74 postintervention (P = .05). Pediatric resident agreement that the electronic discharge process was easy to use increased from 9% to 67% after the intervention (P < .001). CONCLUSIONS: Through multidisciplinary collaboration we facilitated advance preparation of more standardized HDI and decreased related discharge delays from the acute care units at a large tertiary care hospital.
Authors: Aaron M Yengo-Kahn; Natalie Hibshman; Michael Bezzerides; Michael J Feldman; Adam A Vukovic; Nishit Mummareddy; Shilin Zhao; Cody H Penrod; Christopher M Bonfield; E Haley Vance Journal: Pediatr Qual Saf Date: 2021-08-26