Discharge Disposition (Destination)
A discharge disposition is the final destination type and/or health care supports for a patient when they complete an inpatient encounter and leave the associated facility. Dispositions can be anticipated ("expected"), predicted or actual.
Patients may return to independent living (e.g., private residence) at discharge. However, many have needs that can only addressed within a health care facility. Different categories of facilities (e.g., continuing care, acute care, hospice, rehabilitation) have different requirements that must be met before a patient is accepted. Accordingly, it is important to estimate an "Expected Discharge Disposition" as soon as possible, and to adjust transfer preparations accordingly.
Expected vs Predicted vs Actual Discharge Disposition
An "Expected discharge Disposition" can be entered directly within the discharge planning sidebar. When displayed in transition plans, the expected discharge disposition is interactive. Clicking on the hyper-linked description opens a pop-up editor for making quick changes to the expected disposition.
A "Predicted Discharge Disposition" is a probabilistic estimate of the most likely discharge destination type, usually based on an AI model that assesses considerations like the patient's pre-admission frailty, support needs and residence type. Predictive models may focus on the likelihood of disposition change at discharge or whether a patient is likely to manage at home. This information is displayed only if an expected disposition is not yet set.
An "Actual Discharge Disposition" is entered at the time of discharge, usually as part of the discharge order. This value may be pre-seeded by a process for mapping expected dispositions to actual dispositions. Whether blank or defaulted at discharge, prescribers need to confirm that the actual discharge disposition is correct within the discharge order.
Expected Discharge Disposition Editor
The expected discharge disposition editing tool has the same appearance and functions, irrespective of whether it is viewed in the discharge planning sidebar, a pop-up editor, or within discharge navigators.
One or more of the following sections may appear:
Embedded Help
Hyperlinked "[?]" text or symbols can be clicked to access a quick explanations and tips related to setting discharge dispositions.Expected Disposition Pick-List
The drop-down lookup tool can be used to select from among a dozen types (categories) of discharge destination types (e.g., Home, Continuing Care).Expected Disposition Speed Buttons
Commonly selected destinations appear as quick-select buttons that will populate the destination type pick-list without opening that list.Predicted Disposition
If a predictive model has been activated for a patient, and sufficient information is available to make a prediction with a likelihood score above 66%, then the prediction (e.g., change vs no-change, home vs not-home) may be presented within the editor. Once an expected disposition is set, the prediction disappears.Pre-Admit Disposition
If an expected discharge destination type implies a destination facility, then an information block appears that pulls forward details about the type of facility, and facility name, where the patient resided pre-admission.Destination Facility
If an expected discharge destination type implies a destination facility, then a new pick-list appears that can be used to look up and select the specific facility. Note that different lists appear depending upon the selected expected disposition.Repatriation Order
If a RAAPID repatriation order has been placed and is active, a link appears to indicate this. Clicking on the link will open a pop-up display about the status of the repatriation request. If the patient is medically ready for discharge and repatriation may be appropriate (was originally transferred from an out-of-zone facility), then a repatriation order link will appear.Conditional Discharge Order
If a patient is medically ready for discharge and an expected discharge disposition is set, then a Conditional Discharge Order may be appropriate. Clicking on the provided link will open a relevant order panel.
Expected Discharge Disposition Patient List Columns
An Expected Discharge Disposition patient list column ("Exp Disch Disposition", column 3049463001) is part of the Rapid Rounds patient list template and can be added to any "My List" in the patient lists activity. The column has the following properties:
Display
The column displays icons (images) representing different types of discharge destination (e.g., Home, Continuing Care, etc.). If a patient is a "repatriation" candidate, a "return" icon shows in gray (out-of-zone patient eligible for repatriation to a home facility) or green (repatriation order already placed and in process). If an expected disposition is not set, then an icon ("clairvoyant orb") displays to indicate that an AI predicted disposition is available for consideration.Hover
Hovering over a column icon causes a hover bubble to display information relevant to the relevant patient's discharge disposition. This includes the patient's home community, pre-admission residence type, pre-admission facility name, expected residence type, expected residence name, status of any repatriation order and status of any conditional discharge order. Links are provided for immediately initiating repatriatin and/or conditional discharge orders. If an expected disposition is not set, then information from the predicted discharge disposition model appears.Double-click
Double clicking on one of the column icons (within a patient row) causes a popup expected discharge disposition editor to appear. This allows quick review and/or update of disposition details.
Additional columns are available to draw focused attention to a patient's repatriation or discharge order status:
Repatriation Order Status (3049463002)
Display
Coloured dot indicating that an inpatient is a repatriation candidate (out of zone; yellow) or has repatriation order placed (green).Hover
Popup display of expected discharge disposition information (same as for expected discharge disposition column).Double-click
Open expected discharge disposition editor (with access to repatriation information).
Discharge Order Status (30411230801)
Display
Discharge Order indicator of whether discharge order has been placed (green dot) in anticipation of inter-facility transfer.Hover
Popup display of expected discharge disposition information (same as for expected discharge disposition column).Double-click
Open chart to orders activity
Promoting Compliance
Feedback about trends in norms compliance can help clinicians identify potential workflow challenges and consider options for optimizing both the user's experience and the positive impact of Connect Care. Connect Care dashboards are provided for both individuals and groups.
Failure to adhere to meaningful use norms misses opportunities to leverage Connect Care for process and outcomes improvement.