Children's Hospital Colorado

Design of an Electronic Health Record Tool to Improve Pediatric Hospital Discharge Published in Journal of Hospital Medicine

Children's Hospital Colorado | November 01, 2018
Headshot of Mark S. Brittan, MD, MPH

A study released in the Journal of Hospital Medicine highlights an electronic health record (EHR) tool to improve pediatric hospital discharge. The tool makes providers aware of children who will be discharged with multiple medications, home health services or a non-English speaking caregiver. These factors can make the hospital discharge process more challenging for patients and their families, as well as healthcare providers.

The study provides insight into how this electronic instrument can improve the quality of the hospital discharge process for children.

Methods and implementation

Mark S. Brittan, MD and his colleagues, Sara Martin, RN, Leslie Anderson, BSN, Angela Moss, MS, and Michelle R. Torok, PhD, modeled a previously published paper-based discharge planning instrument. A team of clinicians, nurse–family educators, case managers, social workers and informatics experts helped design the instrument in 2014 and it was implemented in the EHR in 2015. The team at Children’s Colorado opted for an electronic tool to automate screening and increase visibility of patients’ home care needs and necessary discharge planning via the EHR. Subsequently, the team of researchers performed statistical analysis to determine if the tool could be used to predict pediatric readmissions.

The instrument generates a score of zero to three points depending on the number of risk factors for each patient. To generate the score, clinical documentation and EHR orders are used to automatically determine the presence of home health services, number of discharge medications, and preferred language of the family caregiver.

The electronic score is displayed within the EHR’s Discharge Readiness Report and is updated automatically as relevant data are entered. It serves as a visual reminder of discharge planning needs around home healthcare, prescription medications, and interpretation services.  

While the tool helps alert inpatient teams to the presence of complex home care and language barriers, analysis showed that there is opportunity to improve the tool’s ability to predict readmissions. The team at Children’s Colorado believes the tool can be enhanced with other variables to improve its value in predicting readmissions. 

Future potential

“As hospitalized children become more medically complex, hospital discharge planning becomes increasingly challenging. We have implemented a real-time electronic tool which helps to identify children with more complex hospital discharges. This tool has the potential to improve the discharge process and reduce unnecessary readmissions,” said Dr. Brittan, assistant professor of pediatrics and Program Director for the Pediatric Hospital Medicine Fellowship program. “We look forward to doing more research on this tool’s impact on discharge planning, preparing families for the transition home, and additional hospital discharge quality metrics.”

The Journal of Hospital Medicine is the premier, ISI-indexed publication for the specialty of hospital medicine and official journal of the Society of Hospital Medicine. The journal advances excellence in hospital medicine as a defined specialty through the dissemination of research, evidence-based clinical care, and advocacy of safe, effective care for hospitalized patients.