ENGAGING PATIENTS IN DISCHARGE PREPARATION AND PATIENT-PROVIDER COMMUNICATION DURING TRANSITIONS: AN INTERACTIVE PATIENT-CENTERED DISCHARGE TOOLKIT

Dr. Anuj K Dalal, MD*1;Theresa E Fuller2;Mrs. Cherlie Magny-Normilus, FNP2;Esteban F Gershanik, MD, MPH, MMSc1;Dr. Robert B Boxer, MD, PHD1 and Jeffrey L Schnipper, MD, MPH1, (1)Harvard Medical School, Boston, MA, (2)Brigham and Women's Hospital, Boston, MA

Meeting: Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev.

Abstract number: 230

Categories: Innovations Abstracts, Technology in Hospital Medicine

Background: The discharge process is often not initiated until late during hospitalization and typically perceived by patients as disorganized. Poor discharge planning is not only a source of dissatisfaction, but may adversely impact safety during transitions. Few efforts have focused on engaging patients in providing real-time input regarding their discharge preparedness prior to leaving the hospital. Preliminary data suggest that managing expectations about discharge can improve patient experience and throughout. Although evidence-based, pre-discharge checklists exist, routine use for discharge preparation is systematically lacking. After discharge, patients often have questions that could be easily addressed by the inpatient care team but typically lack an easy way of communicating with them. Hospitals are implementing electronic health records (EHR), visual dashboards, and secure messaging applications, but few have considered integrating these tools in innovative ways to activate patients and care partners in preparing for discharge and communicating with providers during transitions. Leveraging technology in this way aligns well with hospital key priorities that include improving the patient experience, enhancing patient safety, increasing throughput, and reducing costs.

Purpose:  We report progress on a recently funded AHRQ grant to develop, implement and evaluate an interactive patient-centered discharge toolkit (PDTK) that we are implementing as part of the concurrent BWH Patient Safety Learning Laboratory initiative.

Description: The PDTK (Figure 1) allows hospitalized patients to self-assess discharge preparedness from a patient portal available on mobile devices. Patients are prompted to view key elements of the discharge plan (discharge destination, follow-up appointments) and complete the pre-discharge checklist prior to the expected discharge date. Discharge-preparedness information entered by patients is then displayed on an interactive safety dashboard (integrated into the EHR) and is readily available for providers to view on rounds. Thus, providers can quickly visualize the state of discharge preparedness (red, yellow, green action indicators), identify key concerns and barriers from the patient’s perspective (unaddressed pre-discharge checklist items), and initiate corrective action. Furthermore, the PDTK integrates with secure messaging applications to notify providers when important items have not been addressed, and allows patients to communicate with their attending after discharge to address issues that arise. We are enrolling 500 patients admitted to general medicine units. Of 253 patients surveyed approximately 24-48 hours prior to discharge, only 171 (67.5%) felt prepared and 172 (68%) felt confident that their care team communicated about the discharge plan, suggesting much room for improvement.

Conclusions: The PDTK has been well received by patient advocates, administrators, and nursing and physician leadership primarily because it is well aligned with hospital initiatives related to promoting patient engagement, increasing throughput, and facilitating safety. Our planned evaluation will advance knowledge regarding the use of patient-centered technology for discharge preparation as well as the potential impact on patient activation, self-efficacy, healthcare resource utilization, and patient satisfaction.

To cite this abstract:

Dalal, AK; Fuller, TE; Magny-Normilus, C; Gershanik, EF; Boxer, RB; Schnipper, JL . ENGAGING PATIENTS IN DISCHARGE PREPARATION AND PATIENT-PROVIDER COMMUNICATION DURING TRANSITIONS: AN INTERACTIVE PATIENT-CENTERED DISCHARGE TOOLKIT. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 230. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/engaging-patients-in-discharge-preparation-and-patient-provider-communication-during-transitions-an-interactive-patient-centered-discharge-toolkit/. Accessed November 16, 2019.

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