From the 2023 HVPA National Conference
Morris Jrada MD (NYU Langone Health), Marwa Moussa MD, Michael Wachs MHA, Josephine Ajami RN, MSN
A hospital discharge is a complex process for patients, caregivers and providers. This transition from inpatient to home involves a new diagnosis, medications, appointments and many other multistep follow up actions. At NYU Langone Brooklyn, a new “Team Discharge” initiative was piloted to enhance teamwork, patient centeredness and interdisciplinary communication at time of discharge. We aimed to improve patients’ understanding of the discharge plan.
To describe the “Team Discharge” initiative and processTo review how patients discharged using the “Team Discharge” process improved HCAHPS scores for medicine inpatient discharges to home.
We performed the intervention on a 5 medicine units from February 2022 through March 2023. The intervention included the following steps.
First, the primary nurse messages the patient’s provider that discharge paperwork is printed and all is ready to initiate Team Discharge. Next, the nurse and provider perform a thorough bedside review of all the discharge plans, medications including side effects, discharge instructions such as wound care or diet changes, follow up appointments as well as the after visit summary (AVS) as a team. Once the Team Discharge is complete, the primary nurse enters a smartphrase documenting completion of the Team Discharge process in the patient’s chart. This ensures that every patient that had a team discharge is reportable.
Using an EMR reporting tool, HCAHPS survey responses were linked to “Team Discharge completion” status, based on the presence or lack of a “Team Discharge” note during the encounter. Survey results from patients with a documented note of a completed Team Discharge were compared to patients without the intervention.
Over 13 months, over 5000 patients (50%) were documented as having completed a Team Discharge. Using HCAHPS surveys to measure the impact of the “Team Discharge” process, we noted an improvement in top box scores in many domains of patient experience. Notably, respondents who had a “Team Discharge” documented had a 25% increase in top box scores in the domain of Care Transitions (45% vs. 36%), 22% increase in the domain of Communications about Medications (55% vs. 44%) and 13% increase in the domain of Discharge Information (85% vs 75%) (Fig. 1).
The “Team Discharge” initiative provides an opportunity to bring the entire care team to the bedside at the time of discharge in order to help explain and clarify discharge instructions to patients in a collaborative manner. Compliance of the Team Discharge process continues to grow at NYU Langone Brooklyn, and it is now the primary way patients are discharged from the hospital. While continued education and coaching can help maximize the benefits of this new way of discharging, initial data suggests improvement in several HCAHPS domains, especially Discharge Information, Care Transitions and Communication about Medications.
The “Team Discharge” process has shown to be instrumental in helping patients in a vulnerable time during their inpatient care. It gives front line staff the opportunity to provide a more complete and safe transitions in care by allowing them to review the After Visit Summary with patients and explain any ambiguities in the paperwork. Patients have more often reported better communication about their discharge plan and understanding of their medications through the use of this initiative.