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A quality improvement project aimed to decrease patient discharge times on a medical-surgical unit in Central Virginia. A discharge nurse role and discharge pathway were explored. Through pre/post-questionnaires and pre/post-average weekly discharge patient times, an improvement occurred at project completion.
Keywords: discharge plan, discharge process, discharge nurse role, patient discharge times, interprofessional collaboration
An efficient inpatient discharge involves strategies to improve patient care, increase bed availability, and expedite the timeliness of patient discharge (Stansbury et al., 2021). In 2018, 30% of older adult patients in the United States were reported to encounter a delay in their hospital discharge (Mallipudi et al., 2019). When delays in patient discharge occur, patients are at increased risk for infection and emotional distress, experience increased hospital expenses, and face a delay in obtaining new medications from the pharmacy. In addition, the availability of inpatient beds for incoming patients is restricted (Mallipudi et al., 2019).
Project Site and Reason for Change
The current discharge process for the identified medical-surgical unit incorporated an interprofessional approach with collaboration of the case manager, physician, and assigned nurse. Each nurse completed required discharge paperwork, including medication reconciliation, discharge instructions, follow-up appointments, and patient education. Unit charge nurses often noted the nurse assigned to the discharging patient experienced delays in discharge timing.
In 2019, expected discharge time was 120 minutes or less for all medical-surgical units in this organization. However, on this medical-surgical unit, average patient discharge time of 210 minutes was well over the healthcare organization's benchmark for similar units. Additionally, these results had been unchanged for approximately 3 years. A change in clinical practice thus was needed to reduce patient discharge times from the current weekly average of patient discharge times. An effective discharge planning process and timely patient discharge are needed for busy medical-surgical units such as the project unit.
Many medical-surgical units within this tertiary healthcare organization had great difficulty in decreasing the time-to-discharge and with the discharge process itself. To prevent further financial burden, this quality improvement project was designed to implement a small test of change to determine the impact on one medical-surgical unit that could impact all similar units for the organization.
Program
In the Plan stage of this project (Agency for Healthcare Research and Quality [AHRQ], 2020),...