Electronic Patient Journey Board

Aim

The Electronic Patient Journey Board (EPJB) facilitates timely, safe and appropriate discharge of patients from hospital by promoting a multidisciplinary approach to care coordination and discharge planning. Specifically, the EPJB aims to improve patient flow, multidisciplinary communication and discharge planning by making information about a patient’s journey in hospital visible in a simple format that can be monitored at a glance by the patient’s entire care team.

Outcomes

• reduces average length of stay
• improves communication between care teams
• improves efficiency and the quality of handover processes
• reduces duplication and errors
• improves visibility of ward occupancy
• improves workplace satisfaction and case load management

Background

Managing the patient journey is difficult when the journey is largely invisible to staff. The patient medical record rarely has all the information and it can be difficult to locate. Therefore clinicians rely on verbal communication to clarify the patients care information resulting in:

• repetitive questions
• difficulty tracking progress of allied health referrals
• lack of visible estimated dates of discharge (EDDs)
• amount of clinician time spent searching for patient information
• duplication of patient information
• higher LOS caused by delays in waiting for interventions/reviews.

Discussion and Results

The data reported on the EPJB (including allied health referrals and estimated day of discharge (EDD)), is sourced from the EPJB in ‘real time’ as well as other Queensland Health data sources. It can be updated remotely from any computer or PC around the hospital meaning clinicians do not need to be with the patient to update information but instead, ca input data as clinical decisions are made. Multiple people can be updating information simultaneously.

Key achievements of this Queensland Health initiative include:

• Implementing a cost-effective strategy to improve discharge planning within multiple wards
• Providing a tool for clinical staff that provides a ‘ward at a glance ’view of their unit.
• Successful adaptation of the software to suit surgical, maternity, mental health, cardiology, thoracic, coronary care and sub-acute units.
• The identification of an Expected Date of Discharge (EDD) for an increased number of patients
• Effectively engaging with multi-disciplinary teams – medical, nursing, allied health and administrative staff through local consultation, education and support to achieve the current degree of clinician satisfaction attained.
• A saving of 30-40 minutes per shift, per nursing or ward team, during handover

Lessons learnt

• EPJB works best in conjunction with regular, short, multidisciplinary ‘board rounds’* or team meetings where patient care plans and any new issues are discussed with the entire team, ensuring communication is effective and actions are timely.
• When used in tandem with an Estimated Date of Discharge (EDD)**, the EPJB ensures discharge planning is appropriate, effecting earlier discharge and improved management of patient flow across the hospital.
• Redesigning the patient journey is difficult when the journey is largely invisible to staff, and the patient medical record rarely contains all pertinent information and it can be difficult to locate. As a result, clinicians rely on verbal communication to clarify the patient care information resulting in repetitive questions.

*Daily board rounds are a daily morning meeting which includes all members of the multidisciplinary team. They are generally a short meeting focused on the patient’s progress and planning for discharge.

**The Estimated Date of Discharge is updated at the daily board round.

Further Reading

CSIRO Research Article: Breaking the mould without breaking the system