Abstract
BackgroundTypical solutions for improving discharge planning often rely on one-way communication mechanisms, static data entry into the electronic health record (EHR), or in-person meetings. Lack of timely and effective communication can adversely affect patients and their care teams.ObjectiveApplying robust user-centered design strategies, we aimed to design an innovative EHR-based discharge readiness communication tool (the Discharge Today tool) to enable care teams to communicate any barriers to discharge, the status of patient discharge readiness, and patient discharge needs in real time across hospital settings.MethodsWe employed multiple user-centered design strategies, including exploration of the current state for documenting discharge readiness and directing discharge planning, iterative low-fidelity prototypes, multidisciplinary stakeholder meetings, a brainwriting premortem exercise, and preproduction user testing. We iteratively collected feedback from users via meetings and surveys.ResultsWe conducted 28 meetings with 20 different stakeholder groups. From these stakeholder meetings, we developed 14 low-fidelity prototypes prior to deploying the Discharge Today tool for our pilot study. During the pilot study, stakeholders requested 46 modifications, of which 25 (54%) were successfully executed. We found that most providers who responded to the survey reported that the tool either saved time or did not change the amount of time required to complete their discharge workflow (21/24, 88%). Responses to open-ended questions offered both positive feedback and opportunities for improvement in the domains of efficiency, integration into workflow, avoidance of redundancies, expedited communication, and patient-centeredness.ConclusionsSurvey data suggest that this electronic discharge readiness tool has been successfully adopted by providers and clinical staff. Frequent stakeholder engagement and iterative user-centered design were critical to the successful implementation of this tool.
Highlights
Communication across care teams in hospitals is often disjointed, which can lead to delays in care and adverse outcomes and can negatively affect team dynamics [1,2,3,4]
Stakeholder engagement to inform user-centered design was imperative to ensure that our Discharge Today tool was successfully integrated into existing workflows such that all clinical staff would use this tool with every patient
The important findings of this work are (1) providers, hospital clinical staff, and patients are willing to serve as stakeholders to help guide the user-centered design of an electronic health record (EHR)-based tool and (2) stakeholder engagement during preimplementation, throughout implementation, and into postimplementation results in positive feedback and substantial adoption by clinical staff
Summary
Communication across care teams in hospitals is often disjointed, which can lead to delays in care and adverse outcomes and can negatively affect team dynamics [1,2,3,4]. Typical approaches for moving discharge to earlier in the day and improving the flow of hospitalized patients rely on one-way communication mechanisms, static documentation in the electronic health record (EHR), and in-person care team huddles or telephone calls, which often take place on the day a patient is expected to be discharged [2,15,16,17,18,19,20,21,22]. Multidisciplinary rounds often vary in execution across clinical units; some approaches are more or less effective than others, with variable start times, different clinical staff in attendance, different processes for discussing the discharge of patients, and variable perception of effectiveness [23,24,25] Many of these solutions rely on processes taking place outside of the EHR and interrupt patient care [26,27]. Frequent stakeholder engagement and iterative user-centered design were critical to the successful implementation of this tool
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call