Marin General created multi-disciplinary discharge instructions to give patients more accurate and digestible information.
Our discharge instructions for patients included multiple packets of information from the different disciplines on everything from rehabilitation exercises to follow-up labs and appointments to dates when their durable medical equipment would arrive. Patients would also receive their “official” discharge instructions with their medications and plan of care from their doctor. It was very difficult for patients to manage all of this information on their way out the door—and we found that they generally didn’t read or understand the information. What’s worse, in some situations the different disciplines weren’t aware the patient was getting discharged and weren’t able to give any discharge instructions at all.
Marin General is a non-profit hospital in Greenbrae, CA. It has 250 beds and serves a mainly affluent suburban/rural population with pockets of low-income Latinos, African-Americans, and state prison inmates. Their transitions program began in 2011 and is influenced by the Care Transitions Program and Project RED.
What We Tried
We built multidisciplinary discharge instructions into our electronic medical record. Each role designed their own tab with their own discharge checklist items and modules of information. When a patient is approaching discharge, the doctor goes in and clicks the button that says “Discharge tomorrow.” The entire care team then gets a message that says the patient is close to discharge and they should go in to add any discharge instructions they have. The doctor will review all the instructions the next day, make any modifications that are necessary, then have them printed out for the patient. The current instructions are easier to read and better reflect the recommendations of a variety of key disciplines.
Patients have told us their discharge instructions are easier to read and the different disciplines really appreciate being able to participate in this process officially.
There’s still a lot of work to be done in terms of information design and formatting since we can only integrate so much into our electronic medical record, but the current discharge packet is a significant improvement over what we had before.
When multiple people are contributing to discharge instructions, it can make the physicians’ job more difficult since the various messages from multiple disciplines may not all be in sync. In order to avoid patient confusion, physicians may need to follow up with any disciplines if they notice a discrepancy.
We think our discharge instructions are better now that they’re more inclusive, but we’re also wary of adding too much information and overwhelming the patient again. It’s something we keep monitoring and will work with the disciplines on if needed.