1	The Discharge Assistant: Facilitating Information Transfer at Hospital Discharge G. Stephen Nace, M.D. Assistant Professor of Clinical Medicine University of Illinois College of Medicine - Peoria
2	"“Communication is central to..." “Communication is central to practicing medicine. Articles have documented examples of poor communication among physicians, and... reports have associated poor communication with serious adverse outcomes. Communication among health professionals has been labeled 'a mess.'”¹
3	Adverse events are common when patients transition from hospital to outpatient care¹ 19-23% of patients experience adverse events within 4 weeks after acute care hospitalization Ineffective communication contributed to many of the preventable adverse events Discharge communication should include specific information about: The new discharge medication regimen What follow-up physicians need to do When they need to do it What they should watch for And more effort must be made to effectively communicate this information to the patient
4	Miscommunication about Medications is a Common Cause of Many Adverse Events
5	The most common form of information transfer is the structured discharge summary^1,2 arrive, on average, 2-4 weeks after hospital discharge 66-92% of patients visit their outpatient physicians before complete discharge information is available Between 16 and 53% of patients contact their outpatient physician before arrival of any discharge information For 51% of patients, the discharge summary is never sent to the follow-up physician When discharge communication is delayed or insufficiently detailed, post-discharge management is adversely affected for 10-14% of patients
6	Immediate Discharge Documents¹ 13% omitted a main diagnosis or condition Only 28% had clear F/U plans 60% were received within 5 days A full discharge summary was received within 4 weeks in only 51% Only 12% stated whether further test results were pending 41% specified who to contact if further information was needed...
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9	Current Process
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12	The Challenge Use an evidence-based approach to redesign our current process to facilitate information transfer between providers at the time of hospital discharge
13	Requirements & Constraints immediate utility, minimal development and deployment costs, acceptable to users and readily modifiable based on user feedback, support quality and educational assessment audits, and might assist in the identification of additional functions and features desirable in this and other discharge software applications.
14	Design Specifications Creation of legible documents including: Prescriptions for medications, diet, activity, and self-care behaviors Instructions for patients about followup diagnostic tests and appointments, including dates and addresses Correspondence to outpatient physicians which would contain all pertinent information necessary for follow-up care Use of prompts and error checks to improve the completeness and quality of the documents
15	Design Specifications (cont'd) Emphasize speed of data entry and ease of use by: Minimizing text entry by making extensive use of drop-down menus, option boxes and check boxes Designing logically presented screens which conformed as much as possible to currently used forms and workflow patterns Designing search algorithms which would allow flexible yet efficient lookups.
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28	What Have We Learned So Far? The new process results in information transfer which is: More legible, More timely, and More complete Referring physicians like the new process Output is helpful to have with early re-admissions Discharging residents are mixed in their reviews Major complaint is that it takes too much time... ...but they like it when they are on the receiving end
29	Vision Alternate reference databases (e.g., SNOMED, NDC) Alternate distribution mechanism (fax server +/- email) Incentives for use (e.g., substitute for a dictated summary) Web-based platform Integration with EHR Incorporation within EHR
30	Acknowledgements James F. Graumlich, M.D., Nancy Novotny, R.N., M.S.N., and Jean Aldag, Ph.D OSF-Saint Francis Medical Center This project was supported by grant number 5 R01 HS015084 from the Agency for Healthcare Research and Quality.