From the 2018 HVPAA National Conference
Alice Cusick (Michigan Medicine), Katie Schwalm (Michigan Medicine)
At Michigan Medicine, patients with hematologic malignancies and solid tumors have complex discharge planning needs. Assessments on an oncology service revealed frustration with discharge planning, and data demonstrated the need for improvement in the speed of the discharge process with specific mention about the lack of communication among care providers.
Time constraints precluded the use of a standard face-to-face multidisciplinary discharge planning conference to improve communication. There were no electronic tools available to accomplish this task. To develop an infrastructure for discharge communication that would lead to efficient and quality discharges, the project team assembled a multidisciplinary work group with representatives from physician providers, nursing, care management (CM), social work (SW), physical/occupational therapy (PT/OT), and pharmacy. With a strategic focus on enhancing the patient experience and optimizing quality and safety in patient care, the team worked to promote a culture in which discharge planning starts on the day of a patient’s admission.
A “Shared Note” functionality within EPIC was approved to be piloted on an oncology service and serve as a virtual multidisciplinary discharge planning conference. The note alerts and reminds the care team of what needs to be accomplished prior to discharge and helps formulate thinking and questions early in the patient’s stay by pulling in existing information from the electronic health record (EHR). This information encompasses CM, SW, PT/OT, medication and equipment needs as well as outpatient plans. It also allows for editing and free text.
With the implementation of the Shared Note, we saw higher scores on our discharge communication survey for questions related to staff having the tools, resources, and training related to discharge. Care team survey results indicated that the Shared Note provides one transparent place to access information regarding plans for discharge. The Shared Note has received positive patient feedback, triggered orders to be placed on multiple occasions, and initiated communication around the barriers to discharging the patient. 83% of the targeted patient population between August 2017 – January 2018 had a Shared Note initiated and/or completed at discharge.
This intervention has demonstrated that a multidisciplinary work group helps to understand the workflow on a deeper level and the efficiencies to be gained. Standard work, through the implementation of the Shared Note, contributes to efficient discharge planning and communication. The Shared Note has promoted a culture in which you plan for the entire “stay” and not just the “day.”
Implications for the Patient
A Shared Note for discharge planning houses all the discharge planning information that is typically spread around in different parts of the EHR. A central location for this information improved discharge quality as well as patient and staff satisfaction with discharge planning communication.