Date of Graduation

Fall 12-14-2018

Document Type

Project/Capstone

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Abstract

Abstract

Problem: This project aims to decrease the discharge time of a patient from the hospital once the discharge order has been written. Current discharge times are averaging over 3 hours, leading to a breakdown in the patient throughput process. A patient survey was conducted to determine the reason for prolonged discharge times. The survey revealed that patients are not aware of their day of discharge, which may lead them to being discharged without transportation home. Many studies conclude that there are improvement opportunities around discharge planning and communication.

Context: This quality improvement initiative takes place in a 26-bed, medical-surgical/telemetry hospital department. The patient population is between the ages of 51 and 75 years, with a primary diagnosis of congestive heart failure. The improvement team consists of a CNL student, nurse manager, 2 assistant nurse managers, 2 members of nursing executive leadership, project manager, and 5 RN champions.

Intervention: The intervention is a patient discharge checklist placed within view of the patient on the wall of their room. It was developed by the team, with input from frontline RNs. The nurses will complete the discharge checklist, with patient and family involvement, at the beginning and end of every shift during nurse knowledge exchange (NKE). The discharge checklist will continue to be used during all shifts as RNs check off portions of the care plan as they are met. The RNs will receive an in-service presentation, which includes how to use the checklist focusing on involvement of the patient.

Measures: Measures include discharge times for non-conditional discharge orders from the time the discharge is written to the time the patient discharges, RN and patient survey questions, and HCAHPS scores for two nurse-driven questions.

Results: There was a slight decrease, with less variation, on discharge times. Discharge times decreased from an average of 2 hours and 28 minutes to an average of 2 hours and 11 minutes, a reduction of 17 minutes/patient. There was a variation of 2 hours and 33 minutes to 1 hour and 31 minutes. An unexpected, positive result is readmissions for Department 335 have dropped 3.34% in July and 2.24% in August.

Conclusions: This project did not meet the target of 2 hours; however, there was a reduction from 2 hours and 38 minutes to 2 hours and 11 minutes (a reduction of 17 minutes/patient), improved HCAHPS scores, and a reduction in readmissions. There is more communication between nurses at NKE, patients and family members are more involved with their care, and discharge instructions are better understood. A change in workflow is not easily accepted. By engaging frontline RNs as champions and having them be more involved with their peers for teaching and compliance measures was a successful strategy that had a positive impact.

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