A Mixed Methods SEIPS-based Evaluation of a Patient-centered ED Discharge Process Redesign for Older Adults

Objectives: The transition of older adults from the emergency department (ED) to home remains a potential area of preventable harm. Through a human-centered design process, we developed a patient-centered intervention aimed at improving communication and coordination between ED staff and patients. The intervention included a new electronic health record (EHR)-based template for physicians to enter discharge instructions, a redesigned after-visit-summary (AVS), enhanced nurse training for patient teach-back, and EHR-embedded tips for nurses at the time of follow-up call. Our research objective was to evaluate this patient-centered ED discharge process redesign from multiple perspectives. Methods: Using the SEIPS 3.0 model, we evaluated the intervention, in particular work system barriers and facilitators in the 3 subprocesses of the redesigned ED discharge process: physician writing discharge instructions, nurse/patient communication at discharge, and nurse/patient communication at follow-up call. We used multiple methods to collect quantitative and qualitative data from the perspectives of patients, and ED physicians and nurses. Results: Overall, the redesigned patient-centered discharge process was perceived positively by ED physicians and advanced practice providers, ED nurses, and patients. All 3 groups identified work system facilitators regarding the intervention, in particular the usability of the AVS. Work system barriers pointed to areas for future improvement of the intervention, such as adding prepopulated information to the AVS. Conclusions: Using a human-centered design process, we improved ED discharge for older adults. Our SEIPS-based research and evaluation fit with the learning health system concept as it provides input for future work system and patient safety improvement.