Using an electronic discharge process to improve patient experience and timeliness in a pediatric urgent care setting

Abstract

Background: Most patients in acute care settings are discharged home. Time waiting for discharge paperwork does not add value to patient experience. Quality discharge counseling is critical for patient experience and safety.

Objective: To increase online portal enrollment in order to decrease length of stay through use of an electronic discharge (e-discharge) process.

Patient involvement: We used patient tracers to evaluate the perception of the UC discharge process at baseline, which helped identify barriers to signing up for the patient portal.

Methods: We performed a manual audit of patient encounters twice a month (N = 1431) to determine rate of portal enrollment, e-discharge, and LOS. We calculated summary distributions of LOS for those that received hardcopy vs. e-discharge instructions. We measured the percentage of positive scores for overall experience and quality of anticipatory guidance for all completed surveys.

Results: For audited encounters portal enrollment increased from 22% to 37% (p < 0.001). Encounters with e-discharge instructions had a shorter median LOS compared to patient encounters that received hardcopy instructions (55.0 vs. 68.0 min; p < 0.001). There was no difference in overall rating or perceived quality of anticipatory guidance between groups.

Discussion: Patients who received e-discharge instructions had significantly shorter LOS compared to those who received hardcopy instructions. The overall rating and perceived quality of anticipatory guidance were not negatively affected by e-discharge instructions.

Practical value: Enrolling children into an online portal requires additional steps to ensure that only patients and their legal guardians have access to protected patient information. However, the benefits of offering the portal include shorter LOS without impacting the perceived quality of discharge counseling.

Funding: Children's Mercy supported all phases of this study.

Keywords: Discharge instructions; Length of stay; Patient experience; Patient portal.