Integrating a COVID-19 Discharge Pathway Tool into the EHR

An EHR-integrated COVID-19 discharge pathway tool can boost patient care and mitigate clinician burnout during the pandemic, according to a study published in the American Journal of Medical Quality.  

Patients who tested positive for COVID-19 are especially vulnerable during the discharge process, which throughout the pandemic was fragmented. While some clinicians provided isolation guidance post-discharge, others focused on follow-up protocols.

The researchers integrated the COVID-19 discharge pathway solution at UCHealth system, including the University of Colorado Hospital (UCH) and 11 additional hospitals, to standardize the care transition process and improve patient safety.

The research group aimed to build consensus on discharge readiness criteria, collect and summarize discharge criteria for various discharge locations, and establish standard primary care provider follow-up protocols for patient monitoring.

Researchers evaluated how clinicians utilize the discharge tool and 30-day readmission rates after COVID-19 discharge.

UCHealth system clinicians leveraged the solution 821 times between April 2020 and June 2020, and clinicians discharged 422 patients during this time. The health system readmitted 18 patients (4 percent), while 13 patients (3 percent) had an emergency department visit within 30 days of discharge.

“Effective transitions of care processes are essential for providing high-quality patient care,” explained the study authors. “This fundamental aspect of care becomes even more critical given the unpredictable disease course for patients with COVID-19. The initiative described offers an effective and efficient process for coordinating and standardizing care for patients with COVID-19.”

The integrated solution streamlined clinical guideline integration, complex discharge requirements, mitigated clinician burnout, and standardized complex population care, according to the study authors.

The EHR solution included real-time clinical decision support alerts, which ultimately decreased clinician burden.

“The hospital system’s previously established PCP clinic processes were capitalized on to optimize and standardize follow-up protocols for patients with COVID-19,” wrote the study authors. “Additionally, new processes were built to support uninsured patients who otherwise would have been unable to have timely follow-up. Importantly, the standardized pathway discharge criteria can be adjusted quickly in the circumstance of rapidly rising patient census to prevent further strain on hospital resources.”

The research team noted several factors that led to UCHealth EHR integration:

• Increased urgency
• Clinician buy-in
• Stakeholder engagement
• Open feedback channels for optimization

Furthermore, the consistently optimized solution allowed newly uncovered COVID-19 evidence and experience into one workflow to standardize COVID-19 care across UCHealth.

“Subsequent changes were made quickly to both the pathway content and its information technology components, allowing the pathway to serve as a trustworthy and timely source of information,” wrote the study authors. “Because the solution was fluidly integrated into the EHR, providers could access updated contents easily within their normal workflow.”

The study authors noted conflicting COVID-19 readmission rates at UCHealth, from 9 percent in a separate study to 4 percent in this study.

However, the study authors noted two key variables: the current study authors accounted for the readmission rates for patients discharged by the clinicians at UCH, which accounted for most of the health system’s discharges. Next, the other study accounted for 60-day readmission rates, while the current study only accounted for 30-day readmission rates.

Looking forward, the study authors said health systems could optimize EHR-integrated care pathways for other diseases to standardize patient care across hospitals because clinicians can quickly implement medical orders into a care pathway EHR solution.

“This initiative demonstrates the successful adoption of a rapidly deployed, fully integrated electronic care pathway throughout a large health care system during the crisis situation of the COVID-19 pandemic, to aid in transitions of care,” concluded the study authors. “Institutions should consider using a similar approach for adoption of other high-impact, high-yield clinical pathways.”