This is Part III of our three-part Multidisciplinary Discharge Series.
Kerri: What was the biggest surprise rolling out the Discharge routine?
Pat: Some physicians felt that “All my instructions are orders,” and others thought, “Well all my orders are instructions,” and you know, in the system, orders are put in one place and instructions are put in another. We had to educate the physicians on what the system recognized as an order and as an instruction, which is yet another reason why we created the Discharge Desktop steps. We had all sorts of semantic challenges like this. The other big thing was just how much the physicians relied on the nurses to do their work. That didn’t so much surprise us as much as it challenged us.
Greg: For sites that haven’t rolled this out yet, this is as big as a CPOE implementation. You could probably argue that the most important thing with patients is their discharge instructions. When you think about it, the Discharge routine has really changed the way we discharge our patients. It’s a huge process, and it’s a ton of work, but when its done correctly it’s truly a benefit for our patients.
Kerri: What are you most proud of with this project?
Pat: We never gave up and went back to paper. We put ourselves out there to the extent that physicians and nurses knew we were trying every avenue to come up with the best workflow. It wasn’t easy in our environment, especially since some physicians weren’t advocates of the computer and the regulations. We had to develop teamwork that said, “We have to do this. We have no choice. How are we going to work as a team to keep this going?” Many times, the lead physician would ask, “Should we go back to paper on this?” I’m most proud of the fact that we had the teamwork behind us to not let that happen.
Greg: We are a very large organization with numerous hospitals. We are very proud we were able to standardize all of our nursing and physician discharge documentation. It’s one process for all facilities.
Kerri: What advice would you give organizations that are starting to implement the discharge routine?
Pat: Start with the basics. You can always add more. Sit down and decide exactly what you want to accomplish and exactly what is needed to meet Meaningful Use and what will work for your organization and your culture. If you start with the basics, they will get comfortable more quickly and not feel so overwhelmed. Then, once they get comfortable with the system, you can move on to more complex workflows and do something that is specific to them, and they will embrace it because you are giving them something specifically personalized for them. So for things like DME and Transfer to SNF, you may want to keep those on paper at first so that it gives everyone time to understand the system and get comfortable.
Greg: Get your superusers and end users involved. In order to have a true multidisciplinary routine, you need to have a true multidisciplinary team. You need to include your case managers, social workers, pharmacists, providers, nurses, NPs, and PAs. You need to look to your long term care and assisted living facilities. You need to have this multidisciplinary group not only understand all of it, but also work at a high enough proficiency level to make this process a success.
Join the Discussion
Want more? This webinar aims to keep the Multidisciplinary Discharge conversation going with Pat, Greg, MEDITECH—and you! The roundtable-style session will review article highlights and encourage discussion about the Discharge routine at your organizations.
Sign up for a session today, and submit discussion topics here.
Before You Go
Please see the the Read More section to the right of the page to find supporting documentation, screenshots, and bios. Any questions should be directed to Kerri L. Nash at (781) 774-2605 or kriel@meditech.com.