AI Eases the Peril of Transitions in Hospital Care

Medscape

30-06-2025

Artificial Intelligence (AI) has permeated nearly every sector of American healthcare in one way or another, from democratizing access to a variety of treatments by freeing up the inventory of provider time to developing cutting-edge new treatments that are sure to extend lives and deliver cures to intractable diseases.
As such, one of the most tenuous passages along the medical journey for every hospital patient, the discharge process, has been among the first targets in the sights of healthcare technology teams in trying to better patient experience and outcomes while also reducing provider workloads.
There's certainly no one-size-fits-all approach to implementing AI, but there is one statistic around which there's no argument: A 2023 study found that 50% of healthcare providers of all types are suffering from burnout, and similar statistics have been found in a panoply of other research. One of the factors contributing to this situation is a staffing crunch, which was highlighted in a 2024 infection-control study that found nearly 80% of the 390 hospitals in the study were understaffed. With metrics like these, freeing up the time of clinical personnel is a move toward better patient experience.
Here's a look at three approaches to using AI at this important point of care.
Letting AI Assistants Run the Numbers
The 'capacity crisis' troubling the US health systems sparked the creation of Qventus' Inpatient Capacity Solution. First launched in 2012, and freshly updated last year, this system uses AI to predict optimal patient discharge timing as early as the first morning after admission; stage patient orders in a manner that flows toward achieving early discharge in all patients possible as evaluated on a whole-of-hospital basis; and automates discharge planning, relieving overtaxed clinical personnel of that administrative burden.
'In use at dozens of hospitals in a wide variety of categories, this system touches more than half a million patients per year,' said Jason Cohen, Qventus' chief medical officer, inpatient. 'Overall, we see that it drives up a 30% decrease in excess days, and a 10 times return on investment on average.'
Jason Cohen
Cohen also pointed out a 2023 French study that identified a 40% higher risk for death for older adults who had to stay in the emergency department overnight prior to being admitted to the hospital, underscoring the need to ensure beds are available, especially for the most fragile populations.
A More Patient-Centered Approach to Machine Learning
'Transitions of care can be one of the most dangerous, difficult, and uncertain times in a patient's illness,' said Justin Schrager, MD, emergency physician and chief medical officer of Vital, an AI-powered patient experience company. 'You would be hard-pressed to find an experienced clinician without a healthy fear of care transitions.'
Schrager noted that traditionally, most of these transitions have been extremely high touch, usually led by nurses, and focused as much on emotional support and spiritual benefits as empirical issues like medication reconciliation and parsing through discharge instructions. They tend to have a few other components in common, he said.
'Generally, almost all of them require substantial personnel to manage and avoid a tech-first approach. Additionally, most focus on post-discharge optimization rather than pre-discharge interventions,' Schrager said. 'As a technologist-physician, I see this situation as a truly great opportunity for automation that scales. But when I put on my physician-technologist hat, the key to success is personalization and utilization — something that healthcare technology has struggled with over the years.'
Justin Schrager, MD
Vital's discharge planning works to integrate both worlds, taking all available medical data on the patient as well as their personal information and synthesizing it into a web app. The patient receives instructions via a text message, which links them directly over to the app. Arriving there, they fill out some personal information and are then presented with their care instructions in a visually-appealing user interface and written in plain language; next steps, including any referrals needed; name, address, and phone number of the location where medications have been sent; diagnosis information, including educational videos; access to hospital records, access to the hospital's existing patient portal system; and more.
'This technology can be used to ensure that patients and their family members understand what is being provided to them and make sure that the information provided is actually valuable and personalized,' Schrager said. 'User-based design principles can be leveraged to cut (what's normally a) 10-page document down to a single page, accessible in all languages on a patient's or their family member's device, rewritten using AI to be reading-level appropriate and automatically detecting and surfacing care recommendations from the clinical team that should be present front-and-center.'
Sample outcomes in one study of use of the Vital product, at Dignity Health Arizona, a large healthcare provider within the CommonSpirit Health network, included 4.4-star average patient rating across emergency department and inpatient visits and a 50% improvement in patient experience.
Focusing on the Clinical Staff
The hospitals of Northwell Health, headquartered in New Hyde Park, New York, the state's largest health system, had a problem in common with those served by Qventus and Vital: overburdened, overstressed providers.
In focusing on discharge planning, Jill Kalman, MD, Northwell's executive vice president, chief medical officer and deputy physician-in-chief, led the system to hone in on relieving those providers of some of their administrative work, and Northwell Health, in partnership with Aegis Systems, built a platform called Ascertain.
Jill Kalman, MD
'Having started in a health system, Ascertain has a unique understanding of the complexities and needs of health systems and can seamlessly integrate with and reimagine the way their existing workflows operate,' Kalman said. In addition to health systems, Ascertain also has the ability to be deployed with payers and/or independent provider groups to handle administrative tasks such as documentation, prior authorizations, and compliance.
Kalman said that the platform has been generating strong results for Northwell, enabling nurses, case managers, social workers, and ancillary staff to focus more of their time on patient care rather than administrative tasks. At a time when burnout among healthcare professionals reaches almost half of all those working in the field, this is a crucial modification.
'The fact is, healthcare workers are drowning in a sea of administrative burdens…Ascertain is helping enable more streamlined clinical workflows and therefore improving turnaround times, enabling clinicians to focus less on paperwork and more on patients,' Kalman said. 'Ascertain empowers case managers by providing a single interface to manage communications with clinical teams and payers, surfacing the key medical information they need for conversations with patients and their loved ones, and automating time consuming, manual tasks such as form-filling and navigating portals, all to ensure that patients receive the right care at the right time.'