Developing an Evidence-Based Discharge Process for Patients on a Cardiac/Renal Acuity-Adaptable Inpatient Unit

Introduction: Readmissions continue to negatively impact patient outcomes and create a significant financial burden. Regardless of efforts to reduce readmission rates, the cost of readmission continues to increase. Clinical Problem: All-cause, 30-day readmission rates on a cardiac/renal acuity-adaptable inpatient nursing unit ranged from 11% to 33% from July to December 2018 for patients diagnosed with COPD, AMI, HF, and sepsis. The readmission rate for the organization was 16.2% in September 2018 with a target goal of 14.8%. Project Aim: To use quality improvement tools and an interdisciplinary team to implement the teach-back method during discharge education and a discharge preparedness checklist during hospitalization to enhance patient education, improve patient engagement, streamline the discharge process, improve staff and patient satisfaction with the discharge process, and reduce the readmission rates in patients diagnosed with COPD, AMI, HF, and sepsis. Methods: The A3 report and Improvement Kata method were used to promote progression through the quality improvement process. A detailed process map and a root-cause analysis were used to gain a deeper understanding of the current state. Nurse feedback on the current discharge process was obtained through an informal survey. Inclusion and exclusion criteria were used to determine the data collected pre- and post-implementation. Once the interventions were implemented, iterative PDSA cycles were completed until the target conditions were met. Post-implementation data was collected and analyzed. Results: Use of the teach-back method during discharge education was 75%. Frequency of the presence of the discharge preparedness checklist in the patient’s room was 42.1% and use of the discharge preparedness checklist was 0.7%