Continuing the Care Conversation: the Inter-professional Discharge Summary

1. Continuing the Care Conversation: the Inter-professional Discharge Summary

2. Presenters • Caroline Deerpalsing, RN BNManager, Clinical InformaticsSt. Boniface Hospital • Darcy Hiebert, BN RNClinical Informatics SpecialistManitoba eHealth

3. Winnipeg, Manitoba, Canada Number of employees 4,000 Number of beds 530 Patient days 169, 265 Number of admissions 26,769 Outpatient activity 233,189 Physicians with admitting privileges 583 Affiliated with the University of Manitoba

4. Implemented Allscripts Software Implemented Solutions: • Sunrise Enterprise Registration (2007) • Sunrise Clinical Manager with Patient List, Results (2007) • Sunrise ED Manager (2007) • CPOE with Medication Worklist (2008) • Sunrise Clinical Manager v5.5 SP1 (2011) • Sunrise Enterprise Scheduling (2012) • Clinical Documentation (2012) Future Plans • Version upgrade to 6+ • Medication Reconciliation • Ambulatory Care • Analytics

5. Clinical Documentation Implementation Starter set of electronic clinical documents in the Clinical EPR: • History & Physical • Initial Assessment • Progress Note – Comprehensive • Progress Note – General • Care and Assessment Flowsheet • Consult Note – Comprehensive • Consult Note – General • Discharge Summary • Discharge Summary – Supplemental • Vital Signs Flowsheet • Clinical Summary

6. Learning Objectives • Demonstrate the use of an inter-professional discharge summary document that meets the needs of the communication gap between the acute care facility, patients and primary care provider. • Discuss the implementation successes and how challenges were mitigated in the deployment of the inter-professional discharge summary document. • Review how reports can meet the needs of the patient upon discharge as well as the Primary Care Provider.

7. Current State, Future State

8. Current State • No site wide standardized process • Only a few Clinical Programs were using a standardize form for discharge summary • Some clinical programs had standardized processes • No integrated inter-professional discharge summary • Delay in the recipient’s receiving the Discharge Summary in a timely fashion

9. Future State: Discharge Summary • An inter-professional document used to communicate: • Relevant information & events of the hospitalization • Summary of the patient’s visit • Discharge diagnosis • Discharge instructions • Recommendations to the recipients • Target audience: clinicians’ providing post-discharge care • Finalized by the Most Responsible Medical Staff Member

10. Future State: Discharge Summary • Standardize Discharge Summary for All Clinical Programs • Require a record for the hospital chart for future reference • Improve the timeliness of communication between the hospital and the community • Provide information to patient upon discharge

11. Design • Built a Structured Note to be used by all disciplines • Included Discharge Diagnoses and Other Clinical Conditions • Meets the Health Records Chart Completion requirements by Medical Staff • Able to extract information for Patient Discharge Instructions • Able to send to Care Providers in a timely fashion • Auto-fax Solution

12. Discharge Summary Note

13. Discharge Summary Note

14. Discharge Summary Note

15. Discharge Summary Note

16. Discharge Summary Note

17. Discharge Summary Report

18. Patient Instructions Report

19. Outcomes, Lessons Learned

20. Outcomes • 100% usage by all Attending Providers • To state the discharge diagnoses • 64% Reduction in Dictated Discharge Summaries • 83% Improved Turnaround time for Transcription of Dictated Discharge Summaries

21. Lessons Learned • Documenting workflow is a very simple exercise. It is frequently done with a high level of detail, but every step, no matter how small, needs to be understood.

22. Lessons Learned • Discharge Summary Note is still evolving and will continue to evolve. • Health Issues • Reorganization of Content and Sections • Integrating ADT information into the Report • Explore opportunities for automation

23. Lessons Learned • Remember if Plan A doesn’t work there are 25 more letters in the alphabet • Discharge Summary Note-Supplemental

24. Lessons Learned • Strong leadership is essential to a successful implementation St. Boniface Hospital CMODr. Bruce Roe Manitoba eHealth CMIO Dr. Diamond Kassum

25. Review of Learning Objectives • Demonstrate the use of an inter-professional discharge summary document that meets the needs of the communication gap between the acute care facility, patients and primary care provider. • Discuss the implementation successes and how challenges were mitigated in the deployment of the inter-professional discharge summary document. • Review how reports can meet the needs of the patient upon discharge as well as the Primary Care Provider.

26. Questions