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Electronic formats mean it's time for change
Patient education was expanded
When the Medical University of South Carolina (MUSC) Charleston, SC, prepared to switch to computerized provider order entry (CPOE), one of the first steps for the staff focused on discharge planning was to revise the discharge order set.
"We had a somewhat dated discharge form, which wasn't user-friendly or particularly helpful for patients," says Neal Axon, MD, an assistant professor of internal medicine and site director for Project BOOST at MUSC.
"Like many forms, it suffered from a few generations of tweaks done by different people," Axon says.
"Some of its worst features were that it was unnecessarily cluttered and often completed incorrectly by residents and doctors," Axon explains. "For example, a table that occupied half the page listed every possible discharge disposition from home with no home health services, to home with physical therapy, to home with occupational therapy, and more."
The table included every possible variation, including transitions to long-term care and rehabilitation facilities, he adds.
"At one point in our institution's history, these had been important to track," Axon says. "But it really wasn't essential to discharge processes today, and my feeling and the feelings of others was that we could better use that space and redesign the form."
Another problem was that the form had too little space dedicated to patient education.
So, when the form was revised, the patient education piece was expanded to cover two pages.
"The patient education went from a photocopied, hand-written back half of a page to a two-page, tight document that is much more easy to follow," Axon says. "It's legible and is typed."
Patient education information is available on existing forms for patients with congestive heart failure, acute myocardial infarction, asthma, and other disorders, he says.
The new discharge form is longer, but it's easier to complete, he notes.
"I've had several of the resident doctors say that when we were piloting it, they swallowed hard and cursed to themselves," Axon says. "But after they completed it, they said, 'This form is great.'"
The form was pilot-tested and now is being tweaked. When it's improved and approved, the hospital will roll out a new discharge order set across the institution, Axon says.
The last step will be to make it available in electronic format and plug it directly into the discharge summary module that is part of the CPOE, he adds.
"Right now these are in printable, PDF format," Axon says. "In order to reduce redundancy, the information you complete on the first three pages is automatically filled into the last two pages, which is the patient education piece."
The idea is to have staff log onto the computer, click on the discharge summary module, and then complete several tabs, including a quality tab, he explains.
The discharge form will ask questions pertaining to core measures, such as the following: Does this patient have congestive heart failure?
"What we envision is a one-stop shop for improving our compliance with core measures, and it will be a part of the discharge summary module," Axon says.