Revamping the Discharge Process from UCLA RRMC/SMMC Medicine Services

Project Lead: Will Turner                           

Clinical Leads: Erin Dowling, Wendy Simon 

Project Manager: Brian Le 

Nudge Unit Team: Hengchen Dai, Anna Dermenchyan, Craig Fox, Jeff Fujimoto, Jana Gallus, Richard Leuchter, Allie Lieberman, Jeri Robertson, Silvia Saccardo, Danielle Seiden  

Collaborating Department/Division: Hospital Medicine, DOM Quality 

Project Description: The DOM/Nudge Post Discharge Workgroup is conducting a comprehensive study to revamp the hospital discharge process for UCLA Ronald Reagan/Santa Monica Medical Centers Medicine Services. The project aims to increase the completion rate of post-discharge follow-up appointments for UCLA primary care patients from 55% to 60% within six months of intervention launch and improve the overall post-discharge scheduling workflow. 

The study involves multiple sub-experiments testing different approaches to optimize the discharge order system: 

• Sub-Experiment 1 (Physician Behaviors): Comparing discharge orders only versus discharge orders with Clinical Decision Support (CDS) to improve appropriateness of specialty appointment scheduling
• Sub-Experiment 2 (Patient Behaviors): Comparing discharge orders only versus discharge orders with Discharge Nurse Practitioner (DCNP) PCP scheduling to enhance patient completion of primary care appointments 

The interventions focus on adding structure to the discharge process, implementing clinical decision support tools, and enabling one-click scheduling capabilities. Primary outcomes include completion rates of follow-up appointments within 7 days of discharge and 30-day readmission rates. The project addresses both operational barriers and lesser-known behavioral factors that affect appointment scheduling and completion, building upon lessons learned from previous resource-intensive pilot interventions.