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. It represents a rough estimate of when transition planning milestones are complete and barriers to discharge are resolved. An EDD should be set as soon as possible after admission, with as-needed revisions throughout the hospital stay. Inpatient teams can iteratively discuss and build consensus, with the EDD getting more precise as discharge nears.
EDD editing tools are prominent in admission orders, discharge planning navigators, sidebars and patient lists. The EDD can be entered directly within a variety of workflows, along with observations about factors that might affect the EDD.
EDDs trigger communications and 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.
Declaring an EDD is among meaningful use expectations for prescribers. Compliance is tracked as part of transition planning improvement.
Entering an EDD at Admission
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 which includes the EDD in an "interactive" format (click to enter or edit, then refresh the document).
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). The ELOS number, where it appears in lists or discharge plans, is interactive. Clicking on it will open an "EDD estimate" popup display that maps Alberta ELOS estimates to different categories 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. The estimate guides that appear reflect the specialty of the service to which a patient is admitted.
A remaining length of stay (RLOS, days remaining between present date and EDD) column (#304234723 "AHS IP Remaining Length of Stay") is available in Rapid Rounds and other patient lists, as well as within discharge planning reports. It too is interactive. Clicking on it will open a popup version of the interactive transition plan.
Use of Epic time interval shortcuts makes it easier to pick an EDD 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
Accessing 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
An "EDD" patient list column (#30410301 "AHS Expected Date of Discharge" is found in Rapid Rounds patient list templates and can be added to any personal patient list. Double-clicking on this will bring up an EDD editor.Discharge Planning Sidebar
The Discharge Planning Sidebar can be activated with the Rapid Rounds patient list, or by using the discharge planning report found in chart sidebars (right arrow hyperlink). This contains an EDD and comments editing tool.
Admission and Discharge Navigators
Admission and discharge navigators include a section where the EDD and comments can be edited.Inpatient Chart Storyboard
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.Prescriber Sidebar and Discharge Planning Report
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.
Whether viewed within an inpatient chart sidebar, "Patient Journey" activity or patient list, the EDD displayed in discharge planning reports is interactive. Clicking on it opens a popup tool for adding or editing EDD information.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 (e.g., transport arranged). Discharge orders are also entered when patients transition to a new care setting 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 and inter-facility transfer note templates.
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, can be used. It is also possible to take advantage of the interactive charting found in AHS discharge summary and inter-facility transfer note 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.