Encounter Documentation Norms and related Workflows are  described in the Connect Care Clinician Manual.

The only way to satisfy the encounter documentation norm, and improve the Discharge Documentation Timeliness metric, is to implement processes that assure document completion and signing within the benchmark time interval (48 hours). Connect Care provides a number of tools that facilitate compliance. These include Navigator sections, Notes Activity prompts, Sidebar checklists, patient list report checklists, and In Basket reminders. 

Although there are multiple ways for providers to enter discharge dates and times (e.g., prescriber discharge order, unit manager discharge activity, etc.), the actual date and time of discharge appear in a data field validated by ADT staff. Consequently, provider discharge time ordering or documenting workflows do not affect this metric.

• Manual: Encounter Documentation Norm

Discharge workflow management is supported in Connect Care (Epic) with multiple grouped data elements. Many of these relate to this Metric and its filters.

• Handbook: EDD Metrics Components - EDD

Discharge Documentation Timeliness

Description

• Percentage of discharged acute care inpatients with a discharge summary or inter-facility transfer summary signed or, if required, cosigned within 24, 48 or 72 hours of the actual time of discharge.

Denominator

• Number of Patient Encounters where:

  • Inpatient (EPT 10110 = Inpatient) AND

  • Discharged (EPT 10115 = Discharged) AND

  • Has non-null actual discharge date/time Instant (created from EPT 18855 [Hospital Discharge Date] and EPT 18856 [Hospital Discharge Time])

Numerator

• Number of Patient Encounters from denominator where:

  • Encounter link (EPT 20330) to Encounter Notes list (HNO) INCLUDES an item with 

    • Note Type (HNO 34033) = "Discharge Summary [5]" AND

    • Note Status (HNO 17100) = "Signed" OR Note Status (HNO 17100) = "Cosign Needed" AND

    • Note Action Taken (HNO 34040) = "Sign" 

      • RETURN: Action Taken Instant (HNO 34052) MINUS Hospital Actual Discharge Instant (created from EPT 18855 [Hospital Discharge Date] and EPT 18856 [Hospital Discharge Time])

  • Returned value is LESS THAN OR EQUAL TO 24 or 48 or 72 (three sub-metrics)

Calculation

• Numerator DIVIDED INTO Denominator expressed as PERCENTAGE rounded up to nearest integer percentage point

Filters

• Hospital Speciality Service: EPT 18886 - CATEGORY - (e.g., General Internal Medicine [106])

• Hospital Unit: EPT 18880 - CATEGORY - inpatient unit/ward (e.g., EDM UAH WMC 5D4 GIM [101094229])

• Hospital Facility: EPT 18883 - CATEGORY - (e.g., EDM WMC University of Alberta Hospital [101094])

Analytics Definition

• Crib-Sheet: Timeliness of Discharge Summary

Document Revisions

The first signed (or required cosign) discharge document may not be the final version ultimately shared with external systems. Users are encouraged to use a "Share" button in their document editor while working on a document, alone or as part of a team. Actual signing should be reserved for the accountable prescriber who should take care to complete all required edits before selecting the Sign button. This limitation is of little import to timeliness norm compliance, but does impact the quality and possible safety of what is shared with external systems. It is hoped that popularization of the metric will not incline inpatient teams to premature signing of discharge documents and over-reliance on subsequent edits which increase duplicate management burdens for receiving systems. That there may be outstanding laboratory test results is not a justification of signing-then-re-signing discharge summaries. Rather the summary should specify who is accountable for following up investigations unreported at discharge.

Document Types

All hospital encounters require appropriate summative documentation. However, some encounters end when a patient is transferred to another facility (inter-facility transfer, as opposed to intra-facility transfer). Some users complete a "Transfer Note" (document type 304110000032) to close an encounter for inter-facility transfers, where Transfer Notes should only be used for intra-facility transfers. This Metric does not credit completion of Transfer Notes. In time, users are alerted (In Basket) that a discharge summary document type is required. However, the goal of transition communication may have been satisfied in the time period before the corrective discharge summary is filed. Possible impacts on Metric validity should be considered as long as this practice variation persists. 

Similarily, some surgical services have been using operative notes as encounter summative documentation for short (procedural) surgical stays.

External Documentation

Some users may still use the historical provincial "eScription" document dictation service, or a private service, to transcribe content captured outside of the Connect Care CIS. Placeholders can be inserted into a Connect Care discharge summary document type to indicate where the external dictation will be inserted when complete. Users may sign these provisional documents, satisfying the requirements for this metric, but not for transition communication needs. External dictation workflows are discouraged and are being phased out.

System - Workflow Incongruences

Sometimes patients undergo an intra-facility transfer to a holding or transition ward prior to actual discharge. Such transfers involve a change in the patient's attending prescriber and hospital service, and so discharging service. However, by agreement the holding service requires that the service sending the patient to the holding area prepare and ultimately sign the discharge summary. In these circumstances, the Metric data sources will not reflect the actual discharge summary service and provider accountability.

Radar Dashboards

Reporting Workbench

Slicer-Dicer

Summative documentation management is supported in Connect Care (Epic) with standardized transition planning and documentation components and templates.

• Handbook: EDD Metrics Components - Summative Documentation