Connected Health 2015: Boston Children's Hospital discharge tool puts patient, parents in control

When engaging with patients and families after hospital discharge, Kelly Dunn, R.N., says that a staff nurse at Boston Children's Hospital used to sit at a desk and make calls to each home. That process would take a couple hours, and often the call went to voicemail.

"This was centered on what was working for us, not what that parents needed," Dunn said at the HIMSS Connected Health Conference in Maryland this week. "It wasn't very sustainable, it's not a very efficient use of that nurse's time."

With that in mind, staffers asked themselves: How can we use digital technology to reach out to families?

They came up with a tool called DisCo, or Discharge Communications.

The tool sends families either a text message or email within in 24 hours of discharge that contains a link to a Web-based survey. The form includes three follow up questions:

  1. Does your child have their prescribed medications?
  2. Has a follow-up appointment with the pediatrician been scheduled?
  3. Are there any concerns about your child's condition?

The parents or guardians can then respond "yes," "no" or "not applicable," and submit the form, Dunn said. She added that to keep patient information private, there was no identifying data in the text, email or link.

After the form is submitted, a nurse practitioner can access the responses through a provider dashboard. They can see patient contact information and responses, and can give patient guardians a call if issues are reported, according to Dunn.

In the first pilot phase, from April to October 2013, 140 patients were enrolled, with 73 signing up for DisCo via text, and 67 for email. Of those patients, 67 percent actually used the tool.

The tool then was reviewed and entered into a second pilot phase, which is still ongoing. In that pilot, which was expanded to more hospital floors, 554 patients were enrolled and 286 used the tool. About 30 percent of the respondents have had issues that need to be addressed.  

Dunn said the tool was successful because it put the patients and caregivers at the center. They can respond on their own timeline, using technology that they already own. In addition, it's also simple for clinicians to use, as well as reassuring for them to know if one of their patients needs them.

"The numbers have shown us that, yes, this is good and we're going to try to continue the pilot," Dunn said. "There are a lot of other settings [that want the tool]--radiology, the emergency room."