The Impact of a Nurse-driven Evidence-based Discharge Planning Protocol on Organizational Efficiency and Patient Satisfaction in Patients with Cardiac Implants

The Impact of a Nurse-driven Evidence-based Discharge Planning Protocol on Organizational Efficiency and Patient Satisfaction in Patients with Cardiac Implants

Author: Tracey L. King

Publisher:

Published: 2008

Total Pages: 122

ISBN-13:

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Purpose: Healthcare organizations are mandated to improve quality and safety for patients while stressed with shorter lengths of stay, communication lapses between disciplines, and patient throughput issues that impede timely delivery of patient care. Nurses play a prominent role in the safe transition of patients from admission to discharge. Although nurses participate in discharge planning, limited research has addressed the role and outcomes of the registered nurse as a leader in the process. The aim of this study was determine if implementation of a nurse-driven discharge planning protocol for patients undergoing cardiac implant would result in improved organizational efficiencies, higher medication reconciliation rates, and higher patient satisfaction scores. Methods: A two-group posttest experimental design was used to conduct the study. Informed consent was obtained from 53 individuals scheduled for a cardiac implant procedure. Subjects were randomly assigned to either a nurse-driven discharge planning intervention group or a control group. Post procedure, 46 subjects met inclusion criteria with half (n=23) assigned to each group. All subjects received traditional discharge planning services. The morning after the cardiac implant procedure, a specially trained registered nurse assessed subjects in the intervention for discharge readiness. Subjects in the intervention groups were then discharged under protocol orders by the intervention nurse after targeted physical assessment, review of the post procedure chest radiograph, and examination of the cardiac implant device function. The intervention nurse also provided patient education, discharge instructions, and conducted medication reconciliation. The day after discharge the principal investigator conducted a scripted follow-up phone call to answer questions and monitor for post procedure complications. A Hospital Discharge Survey was administered during the subject's follow-up appointment. Results: The majority of subjects were men, Caucasian, insured, and educated at the high school level or higher. Their average age was 73.5±9.8 years. No significant differences between groups were noted for gender, type of insurance, education, or type of cardiac implant (chi-square); or age (t-test). A Mann-Whitney U test (one-tailed) found no significant difference in variable cost per case (p=.437) and actual charges (p=.403) between the intervention and control groups. Significant differences were found between groups for discharge satisfaction (p=.05) and the discharge perception of overall health (p=.02), with those in the intervention group reporting higher scores. Chi square analysis found no significant difference in 30-day readmission rates (p=.520). Using an independent samples t-test, those in the intervention group were discharged earlier (p=.000), had a lower length of stay (p=.005), and had higher rates of reconciled medications (p=.000). The odds of having all medications reconciled were significantly higher in the intervention group (odds ratio, 50.27; 95% CI, 5.62-450.2; p=.000). Discussion/Implications: This is the first study to evaluate the role of the nurse as a clinical leader in patient throughput, discharge planning, and patient safety initiatives. A nurse driven discharge planning protocol resulted in earlier discharge times which can have a dramatic impact on patient throughput. The nurse driven protocol significantly reduced the likelihood of unreconciled medications at discharge and significantly increased patient satisfaction. Follow-up research is needed to determine if a registered nurse can impact organizational efficiency and discharge safety in other patient populations.


Patient Safety and Quality

Patient Safety and Quality

Author: Ronda Hughes

Publisher: Department of Health and Human Services

Published: 2008

Total Pages: 592

ISBN-13:

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"Nurses play a vital role in improving the safety and quality of patient car -- not only in the hospital or ambulatory treatment facility, but also of community-based care and the care performed by family members. Nurses need know what proven techniques and interventions they can use to enhance patient outcomes. To address this need, the Agency for Healthcare Research and Quality (AHRQ), with additional funding from the Robert Wood Johnson Foundation, has prepared this comprehensive, 1,400-page, handbook for nurses on patient safety and quality -- Patient Safety and Quality: An Evidence-Based Handbook for Nurses. (AHRQ Publication No. 08-0043)." - online AHRQ blurb, http://www.ahrq.gov/qual/nurseshdbk/


Drain’s PeriAnesthesia Nursing – E-Book

Drain’s PeriAnesthesia Nursing – E-Book

Author: Jan Odom-Forren

Publisher: Elsevier Health Sciences

Published: 2022-12-27

Total Pages: 770

ISBN-13: 0323832687

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UPDATED! Revised content throughout provides the most up-to-date information for effective perianesthesia nursing practice. NEW! Full-color layout makes content more visually appealing and highlights important information. NEW! Information on SARS/COVID-19 is now included in the Pathogens chapter. NEW! Chapter on International Care of the Perianesthesia Patient offers complete coverage on this key topic. UPDATED! Coverage of pain management for the perianesthesia patient features the latest guidelines. UPDATED! Patient with Chronic Disorders chapter provides current information on caring for these patients. UPDATED! Evidence-Based Research boxes provide the latest standards of care.


The CMS Hospital Conditions of Participation and Interpretive Guidelines

The CMS Hospital Conditions of Participation and Interpretive Guidelines

Author:

Publisher:

Published: 2017-11-27

Total Pages: 546

ISBN-13: 9781683086857

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In addition to reprinting the PDF of the CMS CoPs and Interpretive Guidelines, we include key Survey and Certification memos that CMS has issued to announced changes to the emergency preparedness final rule, fire and smoke door annual testing requirements, survey team composition and investigation of complaints, infection control screenings, and legionella risk reduction.


Strategies to Improve Cardiac Arrest Survival

Strategies to Improve Cardiac Arrest Survival

Author: Institute of Medicine

Publisher: National Academies Press

Published: 2015-09-29

Total Pages: 291

ISBN-13: 030937202X

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Cardiac arrest can strike a seemingly healthy individual of any age, race, ethnicity, or gender at any time in any location, often without warning. Cardiac arrest is the third leading cause of death in the United States, following cancer and heart disease. Four out of five cardiac arrests occur in the home, and more than 90 percent of individuals with cardiac arrest die before reaching the hospital. First and foremost, cardiac arrest treatment is a community issue - local resources and personnel must provide appropriate, high-quality care to save the life of a community member. Time between onset of arrest and provision of care is fundamental, and shortening this time is one of the best ways to reduce the risk of death and disability from cardiac arrest. Specific actions can be implemented now to decrease this time, and recent advances in science could lead to new discoveries in the causes of, and treatments for, cardiac arrest. However, specific barriers must first be addressed. Strategies to Improve Cardiac Arrest Survival examines the complete system of response to cardiac arrest in the United States and identifies opportunities within existing and new treatments, strategies, and research that promise to improve the survival and recovery of patients. The recommendations of Strategies to Improve Cardiac Arrest Survival provide high-priority actions to advance the field as a whole. This report will help citizens, government agencies, and private industry to improve health outcomes from sudden cardiac arrest across the United States.


Discharge Risk Screening and Interdisciplinary Communication

Discharge Risk Screening and Interdisciplinary Communication

Author: Tammy Linton

Publisher:

Published: 2018

Total Pages: 174

ISBN-13:

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Identification of discharge barriers early during the hospital stay is essential to coordinate services post-discharge. Timely discharge of patients when medically safe controls costs, promotes positive health outcomes, and increases quality of care. Discharge planning is a multifaceted interaction that relies heavily on effective communication between all disciplines and the patient. Research suggests interdisciplinary collaboration and effective communication as leading strategies to mitigate discharge delays. The purpose of this study was to examine the impact of interdisciplinary collaboration on discharge planning and length of stay for medical surgical patients. A daily discharge team meeting was implemented as a best practice strategy to identify barriers, discuss recommendations, exchange ideas, and develop a comprehensive discharge plan. The team consisted of nurses, social workers, case managers, physical therapist, occupational therapist, nutritionist, utilization management coordinators, and physicians. Daily interdisciplinary team meetings (IDT) were implemented Monday through Friday at 11:00 a.m. for four medicine teams for four weeks. This evidence-based solution facilitated shared decision making in the discharge process and improved patient satisfaction related to the discharge process. Collaboration among the interdisciplinary team members was assessed post implementation using a modified Nurse-Physician Collaboration tool (Vazirani, Hays, Shapiro, & Cowan, 2005); 92% of the participants surveyed believed the information exchanged during IDT positively impacted patient outcomes. Length of stay was decreased for three of four medical units and avoidable bed days of care reduced for two of the four units. Substantial research has been done to validate interdisciplinary communication as a best practice to improve the discharge process and patient outcomes. This project accomplished its goal of designing a collaborative model, beginning on patient admission, to ensure efficient and effective discharge planning.


Discharge Planning Guide

Discharge Planning Guide

Author: Jackie Birmingham

Publisher: Hcpro, a Division of Simplify Compliance

Published: 2016

Total Pages: 0

ISBN-13: 9781556459337

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Discharge planning has long been a challenge for organizations, but expected revisions to Medicare's Conditions of Participation(CoP) will increase the burden on healthcare facilities, especially in case management departments, by expanding the number and type of discharge plans that must be created. Discharge Planning Guide: Tools for Compliance, Fourth Edition, is a comprehensive resource on the changes to the CoPs, which are set to revamp discharge planning not just for hospitals, but for postacute providers as well. This book provides guidance on developing a discharge planning workflow during a time when hospitals must create discharge plans for a larger percentage of patients than ever. Essential functions of discharge planning, including patient choice, health literacy, communicating with caregivers, and delivery of notices, are presented in a clear and concise format. The book also covers the connection between discharge planning and the revenue cycle, including payment rules, billing and coding implications, and the appropriate use of several claims forms and condition codes. This book will help you: State the purposes of the Social Security Act, the Conditions of Participation and Conditions for Coverage (CoP/CfC), and the Interpretive Guidelines as each relates to discharge planning Identify sections of the CoPs for discharge planning that relate to discharge instructions Explain how utilization review, discharge planning, and case management interface with transition management Describe steps in monitoring the progress of a patient's discharge plan Describe the effect of the discharge planning process efficiency scores and preventable readmission Describe when to use the Medicare Outpatient Observation Notice (MOON) according to the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act for observation patients Discuss payment rules that affect discharge planning Describe types of discharges and transfers from acute care hospitals, critical access hospitals, skilled nursing facilities, and home health agencies Outline provisions of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 Discuss the revenue cycle implications discharge planning has for hospitals


Best Care at Lower Cost

Best Care at Lower Cost

Author: Institute of Medicine

Publisher: National Academies Press

Published: 2013-05-10

Total Pages: 437

ISBN-13: 0309282810

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America's health care system has become too complex and costly to continue business as usual. Best Care at Lower Cost explains that inefficiencies, an overwhelming amount of data, and other economic and quality barriers hinder progress in improving health and threaten the nation's economic stability and global competitiveness. According to this report, the knowledge and tools exist to put the health system on the right course to achieve continuous improvement and better quality care at a lower cost. The costs of the system's current inefficiency underscore the urgent need for a systemwide transformation. About 30 percent of health spending in 2009-roughly $750 billion-was wasted on unnecessary services, excessive administrative costs, fraud, and other problems. Moreover, inefficiencies cause needless suffering. By one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best performing state. This report states that the way health care providers currently train, practice, and learn new information cannot keep pace with the flood of research discoveries and technological advances. About 75 million Americans have more than one chronic condition, requiring coordination among multiple specialists and therapies, which can increase the potential for miscommunication, misdiagnosis, potentially conflicting interventions, and dangerous drug interactions. Best Care at Lower Cost emphasizes that a better use of data is a critical element of a continuously improving health system, such as mobile technologies and electronic health records that offer significant potential to capture and share health data better. In order for this to occur, the National Coordinator for Health Information Technology, IT developers, and standard-setting organizations should ensure that these systems are robust and interoperable. Clinicians and care organizations should fully adopt these technologies, and patients should be encouraged to use tools, such as personal health information portals, to actively engage in their care. This book is a call to action that will guide health care providers; administrators; caregivers; policy makers; health professionals; federal, state, and local government agencies; private and public health organizations; and educational institutions.


Patient Satisfaction And the Discharge Process

Patient Satisfaction And the Discharge Process

Author: Paul Alexander Clark

Publisher:

Published: 2006

Total Pages: 130

ISBN-13: 9781578397723

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Leaving the hospital setting can be the single most stressful moment of the entire hospital experience--both for patients "and" their families. Research proves that patients' perception of the discharge process an important component to overall satisfaction and loyalty--the final impression of the healthcare experience. How prepared does the patient feel to leave the hospital? How quickly is the discharge process executed? How much thought is given to the self-care instructions the patient takes home? What kind of home care or follow-up services are set in place? Press Ganey has all the right answers! Press Ganey Associates, the recognized national leader in patient satisfaction and quality research, has developed the hands-on, how-to guide you need to improve your facility's discharge process: "Patient Satisfaction and the Discharge Process: ""Evidence-Based Best Practices." Jam-packed with best practices Pulled from data gathered from tens of thousands of patient survey responses in more than 6,000 facilities nationwide, "Patient Satisfaction and the Discharge Process "offers a collection of strategies for providing a successful discharge experience for your patients.The facts you need to improve your discharge planning process The second book in The Press Ganey Series, "Patient Satisfaction and the Discharge Process: ""Evidence-Based Best Practices" delivers 120 pages dedicated to helping healthcare administrators and professionals make measurable improvements to their facility discharge planning process.Based on the best, evidence-based research available For the first time, "Patient Satisfaction and the Discharge Process "brings together the key national studies and the standards of leading agencies--including CMS, the Joint Commission, and the AMA--on discharge process. No other resource offers the applicable data, relevant research, and proven strategies to aid you in quickly and effectively implementing your discharge planning program under HCAHPS--CMS' new initiative to publicly report patient perceptions of care.After reading this book, you will be able to define the differences between patient causes and hospital causes of dissatisfaction with the discharge process. describe the key elements of the AMA Guidance on the components of a quality discharge process. list three things hospitals may do that make patients feel rushed describe two things hospitals do to cause low scores on patient satisfaction with the speed of discharge. identify three questions staff can ask patients that may elicit unspoken concerns or needs. describe five basic living activities that the patient will face post-discharge and that may lead them to not feel confident that they can care for themselves discuss why it is important to have variation in educational resources create an outline for an effective family caregiver assessment describe the potential impact of post-discharge callbacks and home visits on patient concerns about unanticipated needs arising post-discharge. describe the role and use of "education nurses" at one hospital to successfully improve follow-up and patient satisfaction. The Length-of-Stay correlation The best practices found in "Patient Satisfaction and the Discharge Process" have also been identified as key factors for reducing length of stay, improving patient flow, and positively impacting financial outcomes for your hospital. By developing the know-how to improve your discharge planning process and shorten the length of stay for patients, you can achieve better overall quality of care ratings for your facility.Who should read this book? Directors and Managers of Quality Patient Satisfaction Directors and Patient Representatives Risk Managers Directors of Nursing Directors of Case Management Social Workers and Discharge Planners Chief Nursing Officers CONTENTS Introduction Chapter 1: What does the data say Chapter 2: Readiness for discharge Chapter 3: The speed of discharge Chapter 4: Clear instructions on self care Chapter 5: Arrangements for follow-up care and home care Chapter 6: Best practices for focused improvement Conclusion Faculty Disclosure: All faculty participating in continuing education provided by HCPro activities are expected to disclose to the learner any real or apparent commercial financial affiliations related to their presentations and materials.


Re-Engineered Discharge (RED)

Re-Engineered Discharge (RED)

Author: Anniamma Mathew

Publisher:

Published: 2014

Total Pages: 0

ISBN-13:

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Readmission to the hospital is necessary for the continuation of certain treatments and procedures, but majority of readmissions are avoidable. Many research findings established that with proper education and discharge planning, readmission rates can be reduced. This explains the need for a proper discharge process in place for the staff to follow. Readmission leads to poor outcomes to the patients, more hospital stay and a financial burden for the hospitals as well as the patients. Now, Medicare is imposing penalties to hospitals with high readmission rates. For this research, fifteen evidence based literatures were studied which explains many factors concerning the readmission rates, the facts, the reasons, and an efficient method to decrease the rate. This research looks into the current guidelines and practices and the implementation of the Re- Engineered Discharge (RED) using the reviews of the evidence based literatures. In the project RED, the nurse discharge advocate develops the plan for the discharge process along with the multidisciplinary team. The designated nurse discharge advocate follows the patient from the admission, and continues through the hospital stay and transition to the next level of care. This research looks into the current guidelines and practices and the implementation of the RED using the reviews of the evidence based literatures. A team approach, firm adherence to the protocols and continuing education are crucial to decrease the readmission rates.