SHM Converge Scientific Abstract ePoster Gallery-A Clinical Assistant-Led Protocol to Improve Estimated Date of Discharge

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This project describes a clinical assistant-led protocol designed to improve estimated date of discharge (EDD) communication and streamline discharge planning at an urban academic medical center facing hospital capacity and staffing strain. Hospitalists often need to anticipate next-day discharges but lack consistent multidisciplinary support, which can delay discharge despite early preparation.<br /><br />To address this, the team engaged hospital medicine leaders, pharmacy, nursing, unit leadership, and direct care hospitalist service leadership to design a systematic day-of-discharge communication process. The protocol enabled the direct care hospitalist Clinical Assistant to perform two daily touchpoints with the attending team—morning and afternoon—to identify likely next-day discharges and help address barriers. Common tasks included patient/caregiver outreach, care coordination, case management/social work follow-up, meds-to-beds coordination, imaging confirmation, equipment needs, transport, and insurance clarification. A tracking system was created to measure participation and task frequency, with the broader goal of improving EDD accuracy and reducing length of stay.<br /><br />During the October 2023 pilot month, the Clinical Assistant contacted nine direct care hospitalists daily Monday through Thursday and received a 58% response rate to the initial discharge-identification question. Among patients identified for the assisted discharge process, hospitalist discharge orders were placed on average 25 minutes earlier than in non-program patients. However, there was little difference in actual physical discharge time, suggesting remaining delays outside the physician workflow, likely involving nursing and other patient-facing discharge processes.<br /><br />The authors conclude that this model shows promise for improving discharge preparation and physician workflow, but further work is needed to improve team coordination, clarify ownership of discharge tasks, and assess effects on staff satisfaction and patient experience.

Asset Subtitle

Monisha C. Bhatia

Meta Tag

Author List Brandon Scott, Claire Howlett, Connie Li, Monisha C. Bhatia, Prashant Patel

Category Innovations

Concept Estimated Discharge Date

Concept Discharge Communication

Concept Clinical Assistant

Concept Discharge Workflow

Distinguished Non-Finalist

Presenter Organization Ucsf

Presenting Author Monisha C. Bhatia

Track Value in Hospital Medicine

Keywords

estimated date of discharge

discharge planning

clinical assistant

hospital medicine

care coordination

length of stay

discharge communication

multidisciplinary support

hospital capacity

physician workflow

Estimated Discharge Date

Discharge Communication

Clinical Assistant

Discharge Workflow