Background: Patients are most often discharged home after emergency department (ED) care with only verbal communication. Prior research defined this as an important problem to patients, their care partners, and primary care providers. Despite many attempts at introducing written materials, the vast majority of patients at the St. Michael’s Hospital ED receive only verbal information. 

Aim statement: We sought to design a patient-centered discharge information process that would maximize adoption and sustainability.

Measures & Design: The objective was focused on improving four patient outcomes of importance to ED patients defined in the PROM-ED study: Symptom relief, Understanding, Reassurance, and Having a plan for follow up. We developed a core team of designers and clinicians. We performed a review of existing ED discharge tools. Three assistants completed field observations in the ED and participative journey mapping was subsequently completed. Co-design sessions were facilitated virtually. A prototype solution was then tested through cognitive debriefing and cycles of user feedback and refinement. Evaluation/Results Our literature search identified 41 existing discharge tools for ED care which were reviewed. Three assistants completed 63 observation sessions in the ED. The care journey was mapped to identify opportunities for the transfer of information including patient registration, longitudinal ED experience, and final discharge. A prototype was developed and presented over 4 co-design sessions that involved 19 participants divided between patients (6), ED nurses (5), other ED staff (2), family physicians (2), and ED physicians (4). A solution in the form of a patient-oriented chart (POC) was identified as most promising and developed into a prototype. The POC was tested in actual use in the ED and iteratively revised 6 times based on feedback from users and the co-design participants. A late-stage prototype was tested with 7 scenarios through cognitive debriefing with patients in the ED and led to a finalized solution ready for implementation. 

Discussion/Impact: We co-designed a solution to improve discharge information with patients and providers that is focused on improving well-defined patient outcomes and maximizing adoption through consideration of local technological and workflow constraints. The patient-oriented chart provides a template for efficient customized patient-centered discharge information in paper or digital format at the conclusion of ED care.

Authors: Samuel Vaillancourt, Sahil Gupta, Yesmeen Ghader,

Kate Sellen