Author: Tracey L. King

Publisher:

Published: 2008

Total Pages: 122

ISBN-13:

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.