Scarborough develops order set for discharging COVID-19 patients

For patients admitted to hospital with COVID-19, the road to recovery can be harrowing. People with severe illness can undergo intubation, ventilation, and paralytic drugs.

The patient’s recovery continues after discharge, and the coaching and preparation they receive from front-line healthcare professionals is critical.

“These patients have been very sick and they may still have a long recovery ahead of them,” said Dianne Tomarchio, manager of Quality Improvement and Clinical Standardization at Scarborough Health Network.

“Families may worry that we’re sending patients home before they’re necessarily fully recovered,” said Tomarchio. “People wonder if patients may still be contagious. Securing transportation home often proves difficult. There are so many variables and concerns to address to ensure a successful transition home.”

That’s why Scarborough Health Network decided to develop a clinical playbook, called an order set, to specifically address how to discharge COVID-19 patients. And through a partnership with Think Research, a Canadian health technology and clinical content company, this crucial information will now be available through that company’s cloud-based clinical content library, to every hospital in its network.

The order set works as a checklist for doctors, nurses and other hospital staff who are responsible for ensuring that a patient can safely go home. It helps to organize communication to the family doctor and others who will be supporting the patient when they leave the hospital.

If they still need to self-isolate, the order set asks the clinician to confirm that the patient is able to arrange safe transportation home and that their living situation will allow them to follow proper isolation practices.

“Speaking to many doctors and nurses working on the frontlines, they’ve told us what trips them up with COVID is not having any clear standards around when it’s safe to send someone home,” said Kirsten Lewis, vice president of Research and Development for Think Research. “Many people who’ve been affected by COVID are from vulnerable groups – people who have economic challenges, or mental illness and they may have inadequate housing.

“So, if that’s the case, the hospital can help connect patients with the community and bridge them into appropriate housing, and this order set prompts those conversations.”

Standardizing the discharge process in this way also means providing peace of mind to frontline healthcare workers who are already facing an exhausting workload, under the added strain of facing infection risk every day.

“People are struggling with information overload at the frontline,” says Tomarchio. “Having a guided tool at the point of discharge that answers those questions and makes sure that we’re providing the standard of care for our patients is so important. There’s a lot of anxiety around taking care of these patients, about providing the best care, and keeping everyone safe.

“It’s a very difficult time to be working as a frontline care provider. There’s enough stress just coming to work during this time, so developing a tool that can keep staff informed of any changes as things evolve relieves additional stress.”

By making the order set available through the Think Research network and delivering it right to the fingertips of those frontline healthcare workers, Kirsten Lewis’ hope is that more hospitals will be able to provide that support.

“With appropriate planning, we can help prevent patients from falling between the cracks of the system. And that’s where the Discharge Order Set comes in. This tool allows us to ensure that all of the people in the patient’s circle of care, including their family doctor, are aware of what happened to them in the hospital, what treatment they were provided with and what the next steps are.

“All the information and follow up management is organized through the order set and ultimately this can decrease the likelihood that the patient will return to Emergency because of a preventable issue.” To learn more about the COVID-19 Discharge Order Set and the Think Research clinical content library, visit www.thinkresearch.com/ca/covid-19-tools/.