Keniston Angela, McBeth Lauren, Pell Jonathan, Bowden Kasey, Ball Stephen, Stoebner Kristin, Scherzberg Elaina, Moore Susan L, Nordhagen Jamie, Anthony Amanda, Burden Marisha
Division of Hospital Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO, United States.
UCHealth, Denver, CO, United States.
JMIR Hum Factors. 2021 Apr 23;8(2):e24038. doi: 10.2196/24038.
Typical solutions for improving discharge planning often rely on one-way communication mechanisms, static data entry into the electronic health record (EHR), or in-person meetings. Lack of timely and effective communication can adversely affect patients and their care teams.
Applying robust user-centered design strategies, we aimed to design an innovative EHR-based discharge readiness communication tool (the Discharge Today tool) to enable care teams to communicate any barriers to discharge, the status of patient discharge readiness, and patient discharge needs in real time across hospital settings.
We employed multiple user-centered design strategies, including exploration of the current state for documenting discharge readiness and directing discharge planning, iterative low-fidelity prototypes, multidisciplinary stakeholder meetings, a brainwriting premortem exercise, and preproduction user testing. We iteratively collected feedback from users via meetings and surveys.
We conducted 28 meetings with 20 different stakeholder groups. From these stakeholder meetings, we developed 14 low-fidelity prototypes prior to deploying the Discharge Today tool for our pilot study. During the pilot study, stakeholders requested 46 modifications, of which 25 (54%) were successfully executed. We found that most providers who responded to the survey reported that the tool either saved time or did not change the amount of time required to complete their discharge workflow (21/24, 88%). Responses to open-ended questions offered both positive feedback and opportunities for improvement in the domains of efficiency, integration into workflow, avoidance of redundancies, expedited communication, and patient-centeredness.
Survey data suggest that this electronic discharge readiness tool has been successfully adopted by providers and clinical staff. Frequent stakeholder engagement and iterative user-centered design were critical to the successful implementation of this tool.
改善出院计划的典型解决方案通常依赖单向沟通机制、向电子健康记录（EHR）中静态录入数据或面对面会议。缺乏及时有效的沟通会对患者及其护理团队产生不利影响。
应用强大的以用户为中心的设计策略，我们旨在设计一种基于EHR的创新型出院准备沟通工具（今日出院工具），使护理团队能够实时跨医院环境沟通任何出院障碍、患者出院准备状态及患者出院需求。
我们采用了多种以用户为中心的设计策略，包括探索记录出院准备情况和指导出院计划的当前状态、迭代低保真原型、多学科利益相关者会议、头脑书写预演练习以及预生产用户测试。我们通过会议和调查迭代收集用户反馈。
我们与20个不同的利益相关者群体进行了28次会议。从这些利益相关者会议中，我们在将今日出院工具用于试点研究之前开发了14个低保真原型。在试点研究期间，利益相关者提出了46项修改请求，其中25项（54%）成功实施。我们发现，大多数回复调查的提供者报告称该工具要么节省了时间，要么没有改变完成出院流程所需时间（21/24，88%）。对开放式问题的回复在效率、融入工作流程、避免冗余、加快沟通和以患者为中心等方面提供了积极反馈和改进机会。
调查数据表明，该电子出院准备工具已被提供者和临床工作人员成功采用。频繁的利益相关者参与和迭代的以用户为中心的设计对该工具的成功实施至关重要。
