Journal Article

IMPROVING PATIENT THROUGHPUT: IMPLEMENTATION OF A NURSE DRIVEN INTERDISCIPLINARY DISCHARGE CHECKLIST

Payne, Michelle, White, Brooke, Yarbrough, Nicole

2023

Overview

Coordination of Care Improving oncology patient admission efficacy is needed to optimize the patient experience, reduce costs, and stress on the interdisciplinary team. Delays in throughput negatively impact patient care and satisfaction, results in increased length of stay, and increase the likelihood of the need to transition care to an ED while waiting for a bed. Late admission times negatively impact the inpatient care team due to increased workloads during shift change and reductions in available providers and support personnel. One way to improve admission efficacy is to decrease wait times for admission to the inpatient unit. Modifying our approach to discharge was seen as an opportunity to impact throughput as timely discharge was impacting our ability to admit patients. This project aimed to determine if, in acute care oncology teams with high levels of late discharges, would the implementation of a nurseled discharge checklist, when compared to current oncology service discharge practices, affect discharge times and improve interdisciplinary communication regarding patient discharge needs during morning team rounds. Implementation utilized the four-stage, Plan-Do-Study-Act approach. During planning the discharge checklist was created by reviewing common themes delaying discharges after 1400 and input from the interdisciplinary team. Identified checklist items were then translated onto workroom dry-erase boards in a table format. At the beginning of rounds, the unit charge nurse and attending lead the team through the discharge checklist for each patient planned for sameday discharge and anticipated discharge for the next day. Identified discharge needs, issues, outcomes, and updates were noted on the board. The nurse-led discharge checklist has proven to identify discharge barriers, assign ownership, and increase the number of safe discharges before 1400. Opportunities to increase interdisciplinary participation were recognized by decreasing the time needed to attend rounds. Charge nurses are now able to quickly identify and communicate actions needed to expedite patient discharge. Potential cost savings are recognized through reduced length of stay and reduced transitions of care to multiple areas by improving same-day bed availability. Current results demonstrate the value of implementing a nurse-driven discharge checklist into interdisciplinary rounds. The project has expanded to include additional oncology services and work has begun to add a patient discharge checklist to our patient portal.

• Publisher: Oncology Nursing Society
• Subject: Interdisciplinary aspects / Length of stay / Multidisciplinary teams / Oncology / Web portals