Expected Discharge Date (EDD)
An inpatient's Expected Discharge Date (EDD) (also referred to as "Estimated" or "Anticipated" discharge date) is the approximate day that the patient should be ready to transition to the next care setting, including community settings. Inpatient care teams build consensus about the EDD, allowing all to align work and prioritize tasks for timely patient transitions.
Entering an EDD at Admission
Declaring an EDD is among the minimum use expectations for inpatient teams. Compliance is tracked as part of transition planning improvement. EDDs should be:
Set within 24 hours of admission to an acute care facility
Reviewed at daily RAPID rounds or other transition planning meetings
Shared with patients and families
The best way to initiate the EDD at the beginning of a hospital stay is to enter a value within the space provided within an “Admit to Inpatient” order.
Clinicians may worry about the accuracy of an EDD guesstimate entered early in a hospital stay. Use of Epic time shortcuts makes it easier to pick a date that will trigger key transition planning intervals from an estimated time to transition:
For ≤1 day to transition, enter "T+1" in the EDD field
For ≤3 days to transition, enter "T+3" in the EDD field
For ≤5 days to transition, enter "T+5" in the EDD field
For >5 days to transition, enter "T+10" in the EDD field
Connect Care supports the ready entry and continuing adjustment of EDDs for all admitted patients. In general, a first guesstimate is entered as part of the admission order initiating an inpatient encounter. Thereafter, EDDs can be revised to reflect changing circumstances by using interactive EDD displays at multiple points of inpatient workflows:
All patient lists can be customized to include a column displaying patients' EDDs. Clicking on the EDD activates a pop-up editor for fast revision. This feature is part of the Rapid Rounds list used during inpatient multidisciplinary discharge/transition planning.
Admission and Discharge Navigators
These navigators are present in all inpatient charts and include a section where the EDD and comments can be edited within the navigator.
The Storyboard has a section labelled “ADMITTED: …” that shows the EDD. Hovering over this brings up additional information, including a “Discharge Plan” link that can be selected to access a pop-up EDD editor.
The default sidebar (rightmost section of an opened chart) for inpatients has a "transition planning" section that displays the current EDD and supports clicking on that value to access a pop-up editor. The sidebar has an index at the top that allows different sidebar views to be selected, including a "problem oriented charting" sidebar view that also includes an interactive EDD display. These displays also indicate whether discharge is imminent, within 3 days, or longer.
Admitting History and Physical Documentation
Provincially standardized templates for creating admitting history and physical exam documents include an interactive (click to access a pop-up editor) EDD display.
EDD vs Actual Discharge Date or Inter-Facility Transfer Date
An actual discharge date is entered when a discharge order is placed. Normally, discharge orders are entered only when a patient's discharge actually takes place. Discharge orders are also entered when patients transition to a new level of care as part of an inter-facility transfer. The order triggers things like medication reconciliation and generation of an after visit summary. The actual discharge date automatically pulls in to standardized discharge summary notes.
In extraordinary circumstances, a discharge or inter-facility transfer workflow may be delayed (e.g., lack of expected transportation) and clinicians may need to revise the actual discharge date. A new discharge order, with a new discharge date and/or disposition entered, can be used to reflect the changes. It is also possible to take advantage of the interactive charting found in AHS discharge summary templates. The "discharged" or "disposition" subheadings of the note header area can be selected to activate a pop-up editing tool where the discharge date and disposition can be adjusted.