Improving the Discharge Process through the Implementation of a Discharge Nurse

Purpose:
The purpose of this project was to enhance the discharge process through the implementation of a Discharge Nurse. The project goals were to improve parent/caregiver retention of discharge instructions and satisfaction with the discharge process and to reduce readmissions within 7 days of discharge.

Significance:
Public reporting and healthcare reimbursement are linked to outcomes which include readmission rates and patient satisfaction. Therefore, it is essential to have sustainable quality initiatives such as a Discharge Nurse to focus on the discharge process to achieve desired outcomes.

Strategy and Implementation:
The organization conducted an EBP project on the discharge process. The project revealed that post-discharge phone calls were a community standard and an effective way to improve discharge outcomes. Based on this information the organization performed a unit based trial where the bedside nurses would conduct post-discharge phone calls on patients that had been discharged in the past 72 hours. Due to many obstacles this method proved to be ineffective. At this time the role of the Discharge Nurse was created. The discharge nurse meets with families prior to discharge to introduce her role and confirm their contact information. The nurse then calls families within 48 hours to review their discharge instructions, medications, follow-up appointments, and answer questions that have arisen since discharge. Patients that have been identified as being high risk for readmission by the healthcare team are made a priority and may be contacted 2-3 times based on the family's needs.

Evaluation:
The Discharge Nurse role was approved for a 6 month pilot. After successfully achieving desired outcomes, the role was permanently approved. During the pilot, parent/caregiver satisfaction with discharge process increased by 11% and the readmission rate within 7 days decreased by 1.5%.

Implications for Practice:
This project demonstrates the value of post-discharge follow-up phone calls that focus on the reinforcement of discharge instructions. Post-discharge follow-up phone calls may be an investment to implement, however the outcome benefits of reduced readmission rates greatly outweighs the cost.