Development and Implementation of a Multidisciplinary Electronic Discharge Readiness Tool: User-Centered Design Approach

Abstract

Background Typical 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. Objective Applying 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. Methods We 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. Results We 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. Conclusions Survey 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.

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

“…The data collected by the Discharge Today tool are also disseminated via EHR patient worklists, which are EHR-based reports designed to summarize patient care for clinicians using the EHR, and via an automatic paging functionality directly from the EHR. Details can be found in our study describing stakeholder engagement and the user-centered design approaches applied [ 43 ].…”

“…Surveys were conducted using REDCap (Research Electronic Data Capture)—a secure, web-based application for building and managing web-based surveys and databases [ 44 ]—to evaluate the usability of and experience with hospital medicine physicians, APPs, nurses, care management, and other clinical staff during the pilot implementation period. The complete survey results are reported in a study describing the stakeholder engagement and user-centered design approaches that we applied [ 43 ].…”

Human-centered design of clinical decision support for management of hypertension with chronic kidney disease

“…[30] Human-centered design has become a more common design and development process for provider and patient facing health IT applications in the last 10 years [31][32][33][34][35]. Following this approach has been shown to result in systems that are easier to use and lead to greater adoption [36][37][38][39].…”

Communicating Patient Discharge Readiness

“…staff to discharge patients quickly and safely from the hospital. Health information technology (HIT) solutions can help solve patient flow problems, including identifying criteria for discharging patients when they are clinically ready to discharge, [1][2][3] coordinating and communicating about patient discharge readiness, [4][5][6] and helping make informed decisions about capacity allowing real-time capacity management. 7,8 We piloted a Discharge Today tool designed to facilitate real-time communication across clinicians and health care staff about patient discharge readiness with the goal of improving the efficiency of patient discharge.…”

“…We piloted a Discharge Today tool designed to facilitate real-time communication across clinicians and health care staff about patient discharge readiness with the goal of improving the efficiency of patient discharge 4,9. This tool, designed by a multidisciplinary team including hospitalists and information system analysts, is integrated into the electronic health record (EHR) patient worklists commonly used by clinical staff.…”