TABLE 1

HDI Failure Analysis and Targeted Interventions

Root CauseInterventionsMagnitude of Intervention
1. Bundling of discharge order, medication reconciliation, and discharge instructionsSeparated discharge order from medication reconciliation and instructionsBig issue
Made mandatory discharge instructions (wound care, activity, diet, etc) an easily modified “form” rather than an “order”Big issue
2. Suboptimal content (ie, irrelevant information including birth information and immunizations and lack of relevant information for clinical appointments)Modified which information the EHR automatically populates in the HDI (eg, birth information if not birth hospitalization, immunizations from other encounters)Quick hit 1
Reformatted document to emphasize high-yield informationBig issue
Created text templates for subspecialties with clinic informationBig issue
Revised content in HDI for outpatient visit referrals to include clinic address, phone number., provider name, and specialtyBig issue
3. Lack of standard templates for common discharge instructionsCreated short-form text templates for common diagnosis-specific instructionsQuick hit 1
Imposed a character limit to HDIsBig issue
Designed customized long-form service-line templated instructionsBig issue
4. Manual translation of HDI including medicationsStopped translation of medication lists provided in HDI (pharmacies already provided Spanish labels for medications)Quick hit 2
Designed customized long-form service-line templated instructions in SpanishBig issue