Implementing IDEAL Discharge Planning: A Quality Improvement Project on an Inpatient Unit​

Background: Effective discharge teaching reduces 30-day hospital readmissions, decreases unnecessary emergency room visits, improves patient satisfaction, and is cost effective for hospitals by improving the Centers for Medicare and Medicaid Services (CMS) measures for reimbursement. Evidence suggests that standardized discharge teaching templates embedded within the electronic health records lack patient engagement and can fail to meet individual patient discharge education needs. A need was identified to improve the discharge planning process on an advanced care unit in a community based hospital. Purpose: The purpose of this project was to evaluate and assess the implementation of an evidence based toolkit, IDEAL Discharge Planning, on an acute, advanced care hospital unit. Methods: This quality improvement project included surveys that were electronically sent to measure both nursing confidence and nursing perception of the IDEAL tool kit effectiveness. Nursing Confidence Survey scores including brief demographic data (years as an RN, nursing education level, and current FTE position) were collected using an automated response tool (REDCap)both before the implementation of the toolkit and after. Over an 8-week implementation period, nurses utilized the IDEAL Discharge Planning program to engage patients and their families in the discharge education process. Standard of care “after visit summary”(AVS) handouts continued to be provided to patients on the day of discharge although these were enhanced by the IDEAL Discharge Planning program. The number of patient phone calls to the unit were tallied and compared 3 months pre and post-intervention. Patient satisfaction scores, specifically Press Ganey -Patient Discharge Care at Home were collected as a quarterly measure before and after the intervention. Nurses\u27 perceptions of the use and effectiveness of the IDEAL checklists, badge cards, and table tents was collected from the Evaluation of IDEAL Tool Survey using REDCap. Likert-scaled and open-ended responses were collected. Results: A total of 55 registered nurses received education on the IDEAL Discharge Planning toolkit. Of these, 27 provided feedback on the use of the tools and 10 provided pre and post confidence scores. Statistical analysis demonstrated no change in nursing confidence pre and post implementation. Post discharge phone calls to the unit significantly decreased and patient satisfaction scores significantly increased during the post implementation time frame. Nurses reported low frequency of tool usage primarily related to COVID-19 pandemic. Conclusion: Evidence demonstrates that effective discharge education requires engagement with the patient and family during the patient\u27s entire hospital stay. Nurses reported barriers from visitor restrictions that negatively impacted implementation of the IDEAL Discharge Planning toolkit. Implications for practice: This quality improvement project demonstrated some positive impacts on patient satisfaction and should be re-trialed when the visitor restrictions from COVID-19 have been removedhttps://digitalcommons.psjhealth.org/prov_rn_conf_all/1016/thumbnail.jp