Emergency Department Discharge Center Program Evaluation from a "Learning Organization" lens: Methods, Lessons Learned, and Future Directions

Our ED's Discharge Center (EDDC) facilitates appointments and paper-based social determinants of health (SDoH) screening. No criteria guide EDDC utilization. The ED's provider-administrator-run, patient-satisfying follow-up call program contacts only ~25% of discharges. We describe Learning Organization-principle-guided evaluation of EDDC efficiency, aiming to create EDDC time to expand the follow-up program. We reviewed appointment-making, SDoH-screening, and follow-up program data. We surveyed patients to determine whether adopting SHOUT tool criteria (no home, no primary care physician, or insurance) might yield more-judicious EDDC utilization. EDDC staff's 20 minutes/patient yielded fewer ED returns and admissions. Most patients improved post-discharge and made appointments themselves; 6% met SHOUT criteria for EDDC assistance; 4.5% would benefit from SDoH screening. Adopting SHOUT criteria would create significant time for EDDC-staffed follow-up program expansion. QR-code-accessible SDoH surveys would screen thousands more patients, minimizing EDDC staff involvement, saving 95% of the effort while retaining 100% of the benefit.