Discussion
In this study, we used available software to create a bedside e-Board that addressed opportunities for patient-centered improvement in our institution’s discharge process. Patients felt that 3 of 4 software tools on the tablet could enhance the discharge experience. Additionally, we explored patients’ expectations and perceptions of our hospital discharge process.
Key information to inform our current discharge process was divulged by our patients during focus groups. Patients conveyed that the only time that matters to them is the time they get to walk out the door of the hospital, and that general statements (eg, “You’ll probably be going home today.”) create anxiety and dissatisfaction. Since family and care partners need to manage hospital discharge in combination with regular activities of daily life (eg, work schedules, child care), un-communicated changes to the discharge time are very difficult to accommodate and should be discussed in advance. Further, acknowledging the disruption of hospital admission to patients’, their families’, and care partners’ daily lives, as well as being mindful of the impact of interpersonal interactions with patients, remind clinicians of the impact hospitalization has on patients.
Focus group discussions revealed that an ideal patient-centered discharge process would include active patient participation, clear communication regarding the discharge process, especially changes in the specific discharge date and time, and education regarding discharge summary instructions. Further, patients voiced that the unexpected nature of admissions can be very disruptive to patients’ lives and that interpersonal interactions during admission cause emotional responses in patients that influence their perceptions of hospitalization.
Comments regarding poor coordination and communication of internal processes, opportunities to improve collaboration within and across care teams, and need to improve communication with patients regarding timing of discharge and plan of care are consistent with recent studies that used focus groups to explore patient perceptions and expectations around discharge [3,4]. The ramifications of unexpected admissions and the emotional responses patients expressed regarding interpersonal interactions during admission have not been reported by others conducting patient focus groups.
The unexpected nature of many admissions, and the uncertainty of the day-to-day activities during hospitalization, caused patients anxiety and stress. These emotions perhaps heightened their response and memories of both favorable and unfavorable interpersonal interactions. These memories left lasting impressions on patients and care teams may help alleviate anxiety and stress by providing consistency and routine such as rounding at the same time daily, and communicating this time with patients. In this regard, the e-Board was helpful in communicating the patients’ care team and their planned rounding time.
Regarding the ability of e-tools to facilitate information sharing and planning for discharge, patients felt that the display of medications would have been most beneficial when thinking about post-discharge care. They perceived a display of discharge date and time estimate display as very useful to coordinate the activities around physically leaving the hospital, but based on their experiences did not find anticipated discharge times to be believable.
Patients’ perceptions of the tool were assessed after a recent hospitalization, and our data would have been strengthened had patients and their care partners used the e-Board during the actual admission. On the other hand, post-discharge, patients had time to reflect on opportunities for improving their recent admission and had insight into gaps in their discharge that the tool could potentially fill. Because we were unable to access video recordings from our dyad groups, which led us to exclude these participants, we lost care partners’ perceptions of the e-Board and discharge process. Care partners likely have different perceptions of discharge processes compared to patients, and their insight would have augmented our findings.
Several patients observed that the e-Board presented much of the same information that was filled out by care teams on the in-room dry erase boards and questioned whether the tablet was needed. These observations provide future opportunity for studies comparing display of discharge information on in-room dry-erase boards to an electronic tablet display. E-tools have shown some benefit when used for patient self-monitoring [10], to increase patient engagement [11,12], or to improve patient education [12]. Computer tablets may be most useful when used in these manners, compared to information display.
Focus groups provide patient-provided information that is readily actionable, and this work presents patient insight into discharge processes elicited through focus groups. Patients discussed their perceptions of an e-tool that might address patient-identified opportunities to improve the discharge process. Future work in this area will explore e-tools, and how best to leverage their functionality to design a patient-centered discharge process.
Acknowledgments: Our thanks to Mr. Thomas J. (Tripp) Welch for the original suggestion of this study design, and to Ms. Heidi Miller and Ms. Lizann Williams for their invaluable contributions to this work. A special thanks to our exceptional colleagues of the Mayo Clinic Department of Medicine Clinical Research Office Clinical Trials Unit for their efforts in executing this study, and to the study participants who participated in this research, without whom this project would not have been possible.
Corresponding author: Deanne Kashiwagi, MD, MS, 200 First Street SW, Rochester, MN 55902, kashiwagi.deanne@mayo.edu.
Financial disclosures: None.