Association of Interprofessional Discharge Planning Using an Electronic Health Record Tool With Hospital Length of Stay Among Patients with Multimorbidity: A Nonrandomized Controlled Trial

Abstract

Importance: Whether interprofessional collaboration is effective and safe in decreasing hospital length of stay remains controversial.

Objective: To evaluate the outcomes and safety associated with an electronic interprofessional-led discharge planning tool vs standard discharge planning to safely reduce length of stay among medical inpatients with multimorbidity.

Design, setting, and participants: This multicenter prospective nonrandomized controlled trial used interrupted time series analysis to examine medical acute hospitalizations at 82 hospitals in Switzerland. It was conducted from February 2017 through January 2019. Data analysis was conducted from March 2021 to July 2022.

Intervention: After a 12-month preintervention phase (February 2017 through January 2018), an electronic interprofessional-led discharge planning tool was implemented in February 2018 in 7 intervention hospitals in addition to standard discharge planning.

Main outcomes and measures: Mixed-effects segmented regression analyses were used to compare monthly changes in trends of length of stay, hospital readmission, in-hospital mortality, and facility discharge after the implementation of the tool with changes in trends among control hospitals.

Results: There were 54 695 hospitalizations at intervention hospitals, with 27 219 in the preintervention period (median [IQR] age, 72 [59-82] years; 14 400 [52.9%] men) and 27 476 in the intervention phase (median [IQR] age, 72 [59-82] years; 14 448 [52.6%] men) and 438 791 at control hospitals, with 216 261 in the preintervention period (median [IQR] age, 74 [60-83] years; 109 770 [50.8%] men) and 222 530 in the intervention phase (median [IQR] age, 74 [60-83] years; 113 053 [50.8%] men). The mean (SD) length of stay in the preintervention phase was 7.6 (7.1) days for intervention hospitals and 7.5 (7.4) days for control hospitals. During the preintervention phase, population-averaged length of stay decreased by -0.344 hr/mo (95% CI, -0.599 to -0.090 hr/mo) in control hospitals; however, no change in trend was observed among intervention hospitals (-0.034 hr/mo; 95% CI, -0.646 to 0.714 hr/mo; difference in slopes, P = .09). Over the intervention phase (February 2018 through January 2019), length of stay remained unchanged in control hospitals (slope, -0.011 hr/mo; 95% CI, -0.281 to 0.260 hr/mo; change in slope, P = .03), but decreased steadily among intervention hospitals by -0.879 hr/mo (95% CI, -1.607 to -0.150 hr/mo; change in slope, P = .04, difference in slopes, P = .03). Safety analyses showed no change in trends of hospital readmission, in-hospital mortality, or facility discharge over the whole study time.

Conclusions and relevance: In this nonrandomized controlled trial, the implementation of an electronic interprofessional-led discharge planning tool was associated with a decline in length of stay without an increase in hospital readmission, in-hospital mortality, or facility discharge.

Trial registration: isrctn.org Identifier: ISRCTN83274049.

Figure 1.. Activities of the Integrative Hospital Treatment in Older Patients to Benchmark and Improve Outcome and Length of Stay Study Along the Patient Transition Pathway

Step 1 included an early discharge date estimation done by the emergency care team; step 2 involved a systematic assessment of delaying factors (diagnostics and therapy) during hospital stay, a modification of the potential discharge date, and an early assessment and contacting of postacute care facilities; step 3, physicians and nurses performed a timely discussion of pending in-hospital tests, out-of-hospital appointments, changes in medication plan, and strategies in case of clinical worsening at home with patients and relatives. Patient comprehension was assessed using the teach-back methodology. Information was recorded by either physicians, nurses, or social workers and was immediately available to all involved professionals using the EMR.

Figure 2.. Trends in Hospital Length of Stay, 30-day Hospital Readmission, In-Hospital Mortality, and Facility Discharge for Intervention and Control Hospitals Before and After the Tool Implementation

Graphs show population-averaged means for outcomes 1 year before and after the implementation of the intervention. The tool implementation in February 2018 is indicated with dashed vertical lines.