Explore this issue:October 2014
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Editor’s note: Second in a two-part series from SHM’s Information Technology committee offering practical recommendations for improving electronic health records (EHRs) to reduce readmissions. The first article appeared in the September issue of The Hospitalist.
Recommendation: Use EHR workflows to support discharge coaches.
David Ling, MD, is the chief medical information officer at Mary Washington Healthcare in Fredericksburg, Va. His team has applied Project Red functionality to use discharge coaches to improve transitions with EHR support. This intervention reduced readmissions to 7% from 11% from 2011 to 2012; there were no other initiatives during this time.
During this trial, a nurse functioned as discharge advocate, and clinical pharmacists called the patients within 72 hours of discharge. Nursing discharge advocates arranged follow-up appointments, reviewed medication reconciliation, and conducted patient education.
Patients were triaged to the service based on a diagnosis of heart failure, pneumonia, MI, or LACE (length of stay, acuity of admission, Charlson index [modified], number of ER visits in the last six months) risk stratification score greater than eight. The discharge advocate then reviewed prior encounters and determined educational needs.
Patient education was handled using care notes. The discharge advocate was the last person to review the discharge medication list. Pending labs were populated by the discharge advocate.
EHR support of this process required putting all of the discharge-related information in one spot in the EHR to make sure that all processes were completed by the multidisciplinary team prior to discharge.
—Noah Finkel, MD, FHM, Lahey Hospital and Medical Center
Patient-Centric Discharge Instructions
Recommendation: Support EHR build, create patient-centric multidisciplinary discharge paperwork.
At Lahey Hospital and Medical Center in Burlington, Mass., Noah Finkel, MD, and his colleague, Daniela Urma, MD, knew they had a problem with discharge. Paperwork and medication lists were incomplete and illegible. They knew they could not wait until the transition to Epic EHR to solve their problems.
In-house technical expertise created a program called “discharge assistant.” Discharge instructions are added to a common form for all members of the multidisciplinary team. A discharge medication list is imported at discharge from the outpatient EHR. The program allows the provider to note whether a medication is new, changed, or the same, and to add comments and indications to each medication. All of the standard elements of discharge planning are included (i.e., diet, wound care, return to work, diagnosis list, and who to call for specific problems).