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 should discuss and build consensus about the EDD, allowing all to align work for timely patient transitions.
Entering an EDD at Admission
Declaring an EDD is among the minimum use expectations for prescribers. 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. The EDD can also be set within the Admission Navigator or by using the AHS standard Admitting History & Physical template.
Clinicians may worry about the accuracy of EDD guesstimates, especially early in a hospital stay. Use of Epic time shortcuts makes it easier to pick a date that will trigger key transition planning activities:
For ≤1 day to transition, enter "T+1" in the EDD field
For <3 days to transition, enter "T+2" in the EDD field
For <5 days to transition, enter "T+4" in the EDD field
For <10 days to transition, enter "T+9" in the EDD field
For 10+ days to transition (i.e., uncertain or patient is Alternate Level of Care), enter "T+15" in the EDD field
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:
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.
Admission and Discharge Navigators
Admission and discharge navigators include a section where the EDD and comments can be edited.
The Storyboard (left-most column in an opened chart) has a section labelled “ADMITTED: …” that shows the EDD. Hovering brings up additional information, including a “Discharge Plan” link that can be selected to access a pop-up EDD editor.
The default sidebar (rightmost column in an opened chart) has a "discharge planning" section that displays the current EDD and supports one-click access a pop-up editor. The sidebar has an index at the top that allows different views to be selected, including a "planning" and "problem oriented charting" views that include interactive EDD displays. These displays also display EDD intervals (as above), making it easier to appreciate when discharge is imminent.
Admitting History and Physical Documentation
Provincially standardized templates for creating admitting history and physical 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. 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.