Expected Discharge Date (EDD)

An inpatient's Expected Discharge Date (EDD) is the anticipated day that the patient should be ready to transition to the next care setting. An EDD should be set as soon as possible after admission, with as-needed revisions throughout the hospital stay. Inpatient care teams can continue to discuss and build consensus, with the EDD gets more precise as discharge nears. 

EDDs trigger actions that can improve patient flow, allowing all team members to align their work for timely patient transitions. And patients value a sense of how long they will be in hospital.

Entering an EDD at Admission

Declaring an EDD is among meaningful use expectations for prescribers. Compliance is tracked as part of transition planning improvement. EDDs should be:

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. The EDD can also be set within the Admission Navigator or by using the AHS standard Admitting History & Physical template.

Estimating EDDs

Clinicians may worry about the accuracy of EDD guesstimates, especially early in a hospital stay. EDDs are a rough prediction of the expected length of stay (ELOS) for patients with a similar "case mix" (demographics, reason for admission, co-morbidity, frailty). Connect Care integrates easy EDD entry with its "discharge readiness" (inpatient chart side bar and rapid rounds patient list readiness column) popup editor. This includes an "estimate" link that maps Alberta ELOS estimates to different types of presenting problems. These case-mix averages should be increased by 1 ELOS band for a Clinical Frailty Scale > 5 and/or a Charleston Comorbidity Index > 5.

Use of Epic time shortcuts makes it easier to pick a date that will trigger key transition planning activities:

Managing EDDs

Connect Care supports continuing re-adjustment of EDDs to reflect changing circumstances. Interactive (click-to-edit) EDD displays are available at multiple points in common inpatient workflows:

Patient Lists

All patient lists can be customized to include a column displaying patients' EDDs. Double-clicking on the EDD opens a pop-up editor for fast revision. This feature is part of the Rapid Rounds list used during inpatient multidisciplinary discharge/transition planning.

Patient Charts

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 (e.g., transport arranged). Discharge orders are also entered when patients transition to a new level of care as part of an inter-facility transfer. The discharge 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. 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.