Date of Graduation

Summer 8-9-2017

Document Type

Restricted Project/Capstone - USF access only

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

First Advisor

Nancy Taquino

Abstract

Abstract

Improving the Discharge Planning Process in the Orthopedic ERAS Program

Starlite Veloro

University of San Francisco

Background

The Enhanced Recovery After Surgery (ERAS) program is designed and led by a multidisciplinary team of clinicians, performance improvement staff and patient education teams in this large integrated healthcare system. It focuses on improving pain management with less opioid use, early mobility, nutrition and patient engagement, which results in the reduction in the patient’s hospital length of stay (Melnyk, Casey, Black, & Koupparis, 2011). Because on this advancement in practice, it’s crucial that all processes are in place to successfully execute early discharge and decreasing length of stay (LOS). The specific aim of this project is to improve the discharge planning process for patients in the orthopedic ERAS program by mid-July 2017 through the development and implementation of an ERAS discharge planning checklist.

Specific / Global Aim

According to the Regional data from this large integrated health care system, the ERAS performance metrics for this microsystem fell behind other microsystems in meeting the set targets. Hence an ERAS discharge planning checklist will be beneficial since there are still improvements needed around LOS in patients that have undergone total hip surgery. The specific aim of this project is to improve the discharge planning process for patients in the orthopedic ERAS program through the development and implementation of an orthopedic ERAS discharge planning checklist. With the assurance that processes occur postoperatively, this should improve the global aim of this project, which is to decrease the hospital length of stay (LOS) in patients with total hip replacements, under the Enhanced Recovery After Surgery (ERAS) program, from the 2016 baseline hospital LOS of 1.8 to 1.2 by December 2017.

Methodology

The IHI model for improvement framework was used to guide this project. A microsystem assessment using the 5P’s was made and the necessary small test of change was identified to improve the orthopedic ERAS program. Meetings with the management and unit council members of 6-south was needed to establish a collaborative orthopedic ERAS discharge planning checklist. Several PDSA cycles were used throughout this project and the development of an orthopedic ERAS discharge planning checklist was created. Establishing an orthopedic ERAS discharge planning checklist that incorporates key elements to the ERAS program will result in a more robust discharge planning process and the reduction in the patient’s hospital LOS.

Results

Centers for Medicare & Medicaid Services (CMS) bases hospital performance on an approved set of measures and dimensions grouped into specific quality domains (Penner, 2017). When the hospital stay is efficiently managed, the hospital gains incentives from CMS for the timely care provided. The ERAS initiative has impacted and improved many different hospital metrics and indicators. It has been shown to reduce hospital stay, complications, improvements in cardiopulmonary function, earlier return of bowel function and normal activities; benefiting both the patient and hospital (Melnyk et al., 2011).

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