Intervention Title:

Universal Patient Discharge Instructions– Sinai-Grace Hospital; Detroit, Mich.

Goal:

Ensure adult cardiac patients receive all necessary discharge instructions to meet core cardiac-specific measures mandated by the Joint Commission and Centers for Medicare & Medicaid Services (CMS).

Innovation:

Staff developed a systemwide universal discharge instruction form, merging general discharge instructions with cardiac-specific discharge instructions for patients with acute myocardial infarction (AMI) or heart failure (HF).

Result:

In the first nine months of use, adherence to AMI- and HF-specific discharge instructions increased by 21 percent and 29 percent, respectively. The hospital is now consistently meeting discharge guidelines for adult cardiac patients more than 91 percent of the time and continues to see improvement.

Institution:

Sinai-Grace Hospital 6071 West Outer Drive Detroit, MI 48235-2624 P: (313) 966-4246

From the C-Suite:

With this integrated discharge form, we have come close to perfecting our compliance rates for the discharge of cardiac patients. It has helped ensure that all of our patients receive the best possible care from start to finish and has simplified the discharge process for our busy staff.

Conrad Mallet, Jr., J.D. President and CEO, Sinai-Grace Hospital

Profile:

Sinai Grace Hospital is a 404-bed not-for-profit, teaching facility in an eight-hospital system.

Clinical areas affected:

• Cardiology, admissions/discharge

Staff involved:

• Physicians
• Physician Assistants
• Nursing

Timeline:

• Six- to eight-month planning and consensus-building process before implementation

Contact:

Paru Patel, PharmD Administrative Director ppatel@dmc.org P: (313) 966-3272

Innovation Implementation:

The challenge of providing adequate and comprehensive discharge instructions to disease-specific patients is something that all institutions face. For cardiac patients recovering from heart failure or acute myocardial infarction, the disease-specific discharge instructions are particularly important because they are part of a successful evidence-based recovery, as mandated by the Joint Commission and the CMS.

In an effort to ensure highest-quality care, Sinai staff examined HF and AMI discharges and found significant shortcomings in staff compliance with all core measures. Staff struggled with compliance because patients were often treated in different areas across the hospital system and the hospital used multiple discharge instruction forms, including a separate cardiac-specific form. The forms were provided to all units for use with cardiac patients, including the noncardiovascular service units, but providers were still confused about which form to use and routinely just used the general discharge form.

Sinai-Grace addressed this challenge by designing a universal adult discharge form. The resulting Adult Patient Discharge Instruction Record eliminated confusion by merging a cardiac-specific instructions section into the hospital system's existing generic discharge instructions. Now providers use a single discharge form with HF or AMI checklist-style prompts for all mandated evidence-based discharge instructions.

Advice and Lessons Learned:

1. Get input from all staff.

2. Consolidate.

Cost/benefit estimate:

Data show that compliance rates have increased significantly, with adult cardiac patients receiving AMI- or HF-specific discharge instructions more than 91 percent of the time. The new form required no additional staff resources.

All information is current as of June 2008 unless otherwise specified. Please note our Terms of Use.