Date of Graduation

Summer 8-9-2024

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Department/Program

<--Please Select Department-->

Program

Kaiser cohort MSN capstone

First Advisor

Sara Horton-Deutsch, PhD, RN, FAAN, ANEF, Caritas Coach & Leader

Second Advisor

David Ainsworth, DNP, RN, Clinical Nurse Leader

Abstract

Problem: Accurate Expected Discharge Date (EDD) estimates are not just numbers on a chart. They are crucial for optimizing operations, reducing readmission risk, creating safe, timely discharge plans, identifying obstacles, providing transitional care, and enhancing patient satisfaction (Piniella et al., 2023). A hospital-based organization conducted a quality improvement project to improve EDD predictions and discharges, significantly improving patient satisfaction and outcomes. The project had shown that a 12% increase in accuracy, achieving 60% from the baseline of 48%, can be achieved through strong collaboration, transparent communication, and commitment to real-time documentation.

Context: A team analysis improved EDD accuracy, patient satisfaction, and efficiency, focusing on alignment, collaboration, and evidence-based practice integration. The communication plan addressed weaknesses, enhancing patient accessibility to care.

Intervention: Interventions targeted include improving patient tracking with today's EDD using an EDD filter wrenched in the EHR flowsheet, consistent EDD documentation in physician notes, and prep-to-discharge notes entered in the EHR by 9 AM for leadership to review. Timely escalation to mitigate barriers to discharge and enhance communication is crucial. MD and PCC lighting rounds were completed by 1 PM, and EDD updates were entered in EHR by 5 PM, underscoring the importance of timely updates. Plan/Do/Study/Act (PDSA) cycles facilitated the organization of interventions.

Measure: Three parameters were developed to evaluate the efficacy of these interventions using a daily run chart. First, we tracked EDD documentation based on a larger range of MD recommendations. Second, we reviewed the percentage of PCC prep to discharge documentation for patients with EDD of today. Finally, we ascertained the percentage of EDD updates by 5 PM.

Results: While the project did not reach its goal of 75%, it demonstrated a significant improvement in the accuracy of EDD predictions. The 12% increase, from 48% to 60% accuracy, is a substantial step towards our goal and a clear indication of the project's success.

Conclusions: The data identified clear opportunities for further improvement, and the project showed a crucial impact on hospital capacity, overcrowding in the ED, and member care accessibility. The coordination of care department must coordinate these initiatives daily to ensure success and viability.

Keywords: discharge planning, expected discharge date, hospital quality, electronic health records, length of stay, hospital throughput

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