Before-after evaluation of patient length of stay in a rehabilitation context following implementation of an electronic patient journey board

Rolls, David A.; Khanna, Sankalp; Lloyd, Nicola; Reeson, Andrew; Jayasena, Rajiv; McCormick, Christopher; Hakkennes, Sharon

doi:10.1016/j.ijmedinf.2019.104042

Cited by 7 publications

(3 citation statements)

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“…The effects of HISs on these time related measures were mixed. With regard to LOS, following the use of HISs: 14 studies [ 22 – 25 , 29 , 32 , 33 , 36 , 38 , 39 , 41 , 43 , 45 , 51 ] reported a decrease in LOS, 7 studies [ 9 , 52 – 55 , 57 , 62 ] reported an increased LOS and 4 studies [ 58 – 61 ] found no difference. While most of these studies measured LOS in the ED, five studies [ 25 , 39 , 41 , 43 , 45 ] measured inpatient LOS and two studies [ 23 , 59 ] reported changes in patient LOS at paediatrics centres.…”

Section: Resultsmentioning

confidence: 99%

“…With regard to LOS, following the use of HISs: 14 studies [22-25, 29, 32, 33, 36, 38, 39, 41, 43, 45, 51] reported a decrease in LOS, 7 studies [9, 52-55, 57, 62] reported an increased LOS and 4 studies [58][59][60][61] found no difference. While most of these studies measured LOS in the ED, five studies [25,39,41,43,45] measured Patient satisfaction [35,58,62] Boarding Time [22,43,52] Readmission rate [37] Mortality [32] Organisational outcome Hospital costs [33,41,47,53] Film saving [41] Staff satisfaction [49] Staff stress level [35] Process Outcome…”

Section: Impacts On Patient Flow Measuresmentioning

confidence: 99%

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Understanding the impacts of health information systems on patient flow management: A systematic review across several decades of research

et al. 2022

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Background Patient flow describes the progression of patients along a pathway of care such as the journey from hospital inpatient admission to discharge. Poor patient flow has detrimental effects on health outcomes, patient satisfaction and hospital revenue. There has been an increasing adoption of health information systems (HISs) in various healthcare settings to address patient flow issues, yet there remains limited evidence of their overall impacts. Objective To systematically review evidence on the impacts of HISs on patient flow management including what HISs have been used, their application scope, features, and what aspects of patient flow are affected by the HIS adoption. Methods A systematic search for English-language, peer-review literature indexed in MEDLINE and EMBASE, CINAHL, INSPEC, and ACM Digital Library from the earliest date available to February 2022 was conducted. Two authors independently scanned the search results for eligible publications, and reporting followed the PRISMA guidelines. Eligibility criteria included studies that reported impacts of HIS on patient flow outcomes. Information on the study design, type of HIS, key features and impacts was extracted and analysed using an analytical framework which was based on domain-expert opinions and literature review. Results Overall, 5996 titles were identified, with 44 eligible studies, across 17 types of HIS. 22 studies (50%) focused on patient flow in the department level such as emergency department while 18 studies (41%) focused on hospital-wide level and four studies (9%) investigated network-wide HIS. Process outcomes with time-related measures such as ‘length of stay’ and ‘waiting time’ were investigated in most of the studies. In addition, HISs were found to address flow problems by identifying blockages, streamlining care processes and improving care coordination. Conclusion HIS affected various aspects of patient flow at different levels of care; however, how and why they delivered the impacts require further research.

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Section: Resultsmentioning

confidence: 99%

Section: Impacts On Patient Flow Measuresmentioning

confidence: 99%

Understanding the impacts of health information systems on patient flow management: A systematic review across several decades of research

et al. 2022

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“…Typical workflows rely on processes implemented outside of the electronic health record (EHR), such as meetings, paging, and telephone calls, which are inadequate for efficient discharge communication and frequently interrupt patient care [25,26]. Health information technology solutions most often described in the literature include passive communication tools, such as electronic patient journey boards, hospital capacity dashboards, asynchronous electronic reports, and discharge checklists [4,[27][28][29][30][31][32][33][34], or health information technology tools that reside outside of the EHR [35,36]. Even commonly used tools within the EHR, such as messaging or conditional discharge orders, do not provide real time, integrated communications despite being a function of an EHR [37,38].…”

Section: Introductionmentioning

confidence: 99%

The Effectiveness of a Multidisciplinary Electronic Discharge Readiness Tool: Prospective, Single-Center, Pre-Post Study (Preprint)

Keniston¹,

McBeth²,

Pell³

et al. 2021

Preprint

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BACKGROUND In the face of hospital capacity strain, hospitals have built multifaceted plans to try to improve patient flow. Many of these initiatives have focused on the timing of discharges and lowering length of stay and have been met with variable success. We deployed a novel discharge communication tool in the electronic health record (EHR) to enhance communication around discharge. OBJECTIVE Evaluate the effectiveness of a discharge communication tool METHODS We conducted a prospective, single center, quasi-experimental, pre-post study with Hospitalist physicians and advanced practice providers to evaluate the Discharge Today Tool, an electronic health record (EHR) communication tool. We assessed adoption of the tool as well as the usability of and experience with Hospital Medicine physicians, advanced practice providers, nursing, care management, and other clinical staff during the pilot implementation period. In addition, using multivariable mixed modeling, we compared discharge order time, discharge time, and length of stay during a pre-implementation period (October 1, 2018 to March 4, 2019), the pilot implementation period (March 5, 2019 to July 31, 2019), and a post-implementation maintenance period (August 1, 2019 to December 31, 2019). RESULTS During the pilot implementation period, from March 5, 2019 to July 31, 2019, 4,707 patients were discharged (compared to 4,558 patients discharged during the pre-implementation period). Three hundred and fifty-two clinical staff had wrenched in the tool and 85% percent of patients during the pilot period had a discharge status assigned at least once. In a survey of hospital medicine providers and clinical staff, the majority of respondents reported that the tool was helpful and either saved time or did not add additional time to their workflow. Although improvements were not observed in either unadjusted or adjusted analyses, after including starting morning census per team as an effect modifier, there was a reduction in the time of day the discharge order was entered into the EHR by the discharging physician and in the time of day the patient left the hospital (decrease of 2.9 minutes per additional patient, P=0.07 and 3 minutes per additional patient, P=0.07, respectively). After adding teams staffed with an advanced practice provider (APP) as an effect modifier, for teams that included an APP, there was a significant reduction in the time of day the patient left the hospital beyond the reduction seen for teams without an APP (decrease of 19.1 minutes per patient, P=0.04). Finally, in adjusted analysis, hospital length of stay decreased by an average of 3.7% (P=0.06). CONCLUSIONS The Discharge Today tool allows for real-time documentation and sharing of discharge status. Our results suggest an overall positive response by care team members and that the tool may be useful for improving discharge time and length of stay if a team is staffed with advanced practice provider (APP) or in higher census situations.

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Hospital Access Block: A Scoping Review

Clark¹,

Islam²

2022

Journal of Emergency Nursing

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Before-after evaluation of patient length of stay in a rehabilitation context following implementation of an electronic patient journey board

Cited by 7 publications

References 10 publications

Understanding the impacts of health information systems on patient flow management: A systematic review across several decades of research

Understanding the impacts of health information systems on patient flow management: A systematic review across several decades of research

The Effectiveness of a Multidisciplinary Electronic Discharge Readiness Tool: Prospective, Single-Center, Pre-Post Study (Preprint)

Hospital Access Block: A Scoping Review

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