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Mount Auburn Hospital has developed a meticulous discharge process, improving the quality of communication and enhancing patient care.

Andrew Modest, M.D, is a hospitalist at Harvard Vanguard Medical Associates, which is affiliated with Mount Auburn Hospital in Cambridge, a teaching hospital of Harvard Medical School. Dr. Modest has led a novel approach to improving communication at the point of discharge. “I’ve been very interested in this part of my work because I see it as a time when patients are particularly vulnerable. There is a lot of opportunity to create better systems to assure that we’re more rigorous with our discharge planning.”

Mount Auburn Hospital educators recognize that a great deal of clinical and academic energy is spent at the time of hospital admission. The medical team dedicates time reviewing and discussing various diagnostic possibilities, which may be causing the symptoms a patient has, then formulating a diagnosis. However, it’s time to recognize that the other end, discharge, provides an excellent teaching opportunity as well – to patients, their families and the medical care staff.

The phrase ‘Discharge Time-Out’ comes from a JCAHO (Joint Commission Accreditation of Hospital Organizations) mandated pre-operative time-out. That time-out occurs before surgery can begin, and the entire surgical team stops what they’re doing to go through a ‘checklist’ to assure safety. “This is an effective mechanism for reducing intra-operative errors,” explains Dr. Modest.

Mount Auburn Hospital is using that same concept and applying it to the patient discharge process. “We get the medical team together again to make sure we’ve done everything right. Have we addressed all of the patient’s needs during hospitalization? Are we able to reformulate the case and correctly identify what the after-care plan needs to look like?” says Dr. Modest.

The hospital’s process for medication reconciliation feeds right into Discharge Time-Out. Physicians must define what medications a patient is being discharged on, and must also document the discontinuation of any medications that were prescribed prior to the hospital stay. “That in and of itself prevents a certain category of medication errors,” says Dr. Modest.

After the medical care team has fully reflected on a case, one member of the team (usually the attending physician) sits with the patient and family, if appropriate, to talk about the team’s findings and the next step in care. At this time, physicians must also clearly explain to the patient what medications they were taking when they arrived at the hospital, and what changes in medications have occurred (if any) and why.

“Ideally, this is the conclusion of an ongoing conversation with the patient as to what has progressed since admission,” says Dr. Modest. He says what comes out of the Discharge Time-Out is a concise, organized synopsis of the case, which enables the physician to create an appropriate discharge summary containing all of the pertinent information the patient’s primary care physician or next physician will need to assume immediate care. This summary also highlights lab results and tests, which may still be outstanding at the time of discharge.

“The house staff (residents and interns) are extremely responsive to the learning opportunity Discharge Time-Out provides. The primary care physician or next clinician receiving the patient benefits dramatically, because they’re now equipped with much more accurate and comprehensive information,” says Dr. Modest. “Patients benefit dramatically as well. They appreciate the quality of communication and care.”

For a free Patient Health Record Pamphlet, please call us at 617-499-5094.