Discharging a patient from the hospital is a complex and highrisk task. Patients require clear and understandable instructions from their discharging providers in order to successfully transition from the hospital back to the home setting. Several prominent projects on this subject, such as Project BOOST, have established best practice standards for what should be included in patient discharge instructions.
We saw an opportunity at our institution to improve the content, clarity, and standardization of our hospital discharge instructions with the scheduled implementation of a new electronic medical record.
A basic discharge instruction template was developed for use with the golive of the EMR. Material from Project BOOST, Project RED, and other quality improvement efforts around hospital discharge was used to create this template. Key formatting features included the use of sixthgrade reading level language and the use of the second person (e.g., “you were admitted to the hospital because…”). Key content elements included prompts for activity instructions, diet instructions, tests and treatments performed in the hospital, problems or symptoms to look for following hospital discharge, provider contact information, and follow up appointment information. In order to make the template for attractive to providers, we embarked on a campaign of “mass customization”: all inpatient services were offered the opportunity to have their own “variation” of the basic template. These other template versions would keep all of the basic best practice elements, but could be configured to be very servicespecific in terms of content. We ended up developing 27 iterations of the basic template for multiple inpatient services. In order to assess the utility of the template in achieving best practice standards for discharge instructions, we performed a retrospective review of 516 inpatient cases across all hospital services six months following golive of the new EMR. We found that providers were using a template 86% of the time (as opposed to entering free text instructions); the high volume services of Medicine, Orthopedic Surgery, and General Surgery were using a template over 95% of the time. Specific follow up information was present 93% of the time when a template was used, compared to 73% of the time without template use. Specific information regarding problems and symptoms to watch for following discharge was present 94% of the time when a template was used, compared to 61% of the time without template use. Patients received information on the tests and treatments performed in the hospital 97% of the time with template use, compared to only 4% of the time without template use.
Using “mass customization” when building discharge instruction templates in an EMR can result in high rates of use by providers, and can substantially improve the standardization and quality of discharge instruction content.
To cite this abstract:Clay B, Goldman S. Development and Use of a Mass Customized Discharge Instruction Template to Standardize and Improve Discharge Instruction Content. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97687. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/development-and-use-of-a-mass-customized-discharge-instruction-template-to-standardize-and-improve-discharge-instruction-content/. Accessed August 23, 2019.