Discharge Task Force: A Nurse Driven Evidence-Based Practice Model

Purpose: Our project began after noticing high observation lengths of stay, long discharge-to-door times, inefficient emergency room through-put, and a lack of standardization in the discharge process. We adapted a multidisciplinary, nurse-driven approach to meet the operational needs of the institution and maintain a high patient and employee satisfaction. This approach was intended to create an environment that fosters efficiency, safety, collaboration, higher quality of care, leadership, and growth. A more engaged staff leads to higher quality of care, better patient outcomes, and ultimately, institutional sustainability within a changing healthcare environment. Method: A data review revealed opportunities for improvement within the discharge process, and as a result, the discharge task force was formed. This task force was composed of nursing staff, operational leaders, and physicians from every department involved in patient care from admission into the hospital until discharge. We created metrics to measure and track each stage of the process. The discharge portion was the first initiative of the task force. Findings: At the completion of our initiative, we reduced our discharge-to-door time by 45.3 percent. We reduced our overall length of stay by 15.6 percent. Our patient satisfaction scores under the discharge portion, measured by Press Ganey, rose by 30.2 percent. Our overall patient satisfaction score percentage of fives rose by 20.2 percent. At the unit level, we have seen an increase in staff engagement and involvement. The nursing staff took on leadership roles and built a sense of autonomy while promoting growth, and they were given a new sense of cooperation and collaboration between departments. The initiative became a model for success that has been replicated within the inpatient units and other institutions. Discussion: Our evidence-based practice initiative was divided into three phases—Cultivating Purpose and Transparency, the Prime-Time Showcase, and Ground Control—a new phase being introduced each month. Cultivating purpose and transparency began with bi-weekly meetings in which we updated the staff on our current discharge times, staff expectations, and our goals and initiatives moving forward, and discussed the importance of these improvements to the patients, their families, and the institution. With the development of the Prime-Time Showcase, a communication tool for the unit clerks and nurses, we were able to bridge a communication gap that existed within the nurse’s work flow. Phase three initiated the ground control team and was the final and most important phase of the initiative. It transformed the initiative into a self-sustaining hospital norm driven by bedside nurses because it gave the nurses the opportunity to drive and influence change at the unit level. Implications for Practice: Based on our results, the implementation of the Discharge Task Force initiatives led to a reduction in the overall length of stay, and simultaneously increased patient and employee satisfaction. The Discharge Task Force initiatives have provided a methodology for success in a variety of hospital units in a changing healthcare environment