Discharge Process Improvement in Acute Care

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Table of Contents

Introduction
Discharge Process in an Acute Care Setting
Purpose and Significance
The Use of Care Coordination Rounds and a Departure Lounge
Discharge Process in Nursing
Conclusion
References

Introduction

Discharge planning is an important process in the treatment and stay of a patient in the hospital. At the time of discharge, the person must be examined, all relevant paperwork completed, and procedures finished that takes a significant amount of time. That is why it is important to create an efficient check-out process that reduces the time spent by patients in the departure lounge. Speeding up patient flow is beneficial for visitors and for the hospital. This reduces the risk of people re-infecting themselves in the waiting room and reduces their total time spent in the hospital environment (Emes et al., 2018). For medical institutions, it is important to increase the ability to accept more patients and not waste additional resources on people who go home or to another type of facility (Emes et al., 2018). Therefore, medical professionals are constantly improving the discharge planning process and introducing new approaches.

Discharge Process in an Acute Care Setting

Discharge planning is a complex step in acute hospitalization, starting as soon as the patient’s doctor decides that they are ready to leave the hospital. The discharging process includes the coordination of all teams involved in patient care, and communication with the patient and their relatives (Alper et al., 2017). When making an appointment for discharge, the doctor checks the patient’s cognitive status, their functional state, suitability of housing conditions for recovery, availability of support, the ability to receive medication, etc. (Alper et al., 2017). The first step is to conduct and complete all planned procedures and analyses (Alper et al., 2017). Then there is a prescription of medicines and a discussion with the patient about the medication schedule and possible side effects and concerns (Alper et al., 2017). The medical staff must draw up a hospital discharge summary that communicates a personal care plan, which can be used by the patient or the medical staff of the institution to which he is sent.

The discharge process is important and involves interprofessional cooperation; therefore, any problems in the process lead to patient delays in the hospital. It can be hindered by communication barriers between healthcare providers – doctors, therapists, nurses, pharmacists, and social workers who take part in the treatment and post-hospital care (Pinelli et al., 2017). The most common instances of delays include coordinating and waiting for the dispensing of medicines (61%) and failures in the transfer and execution of documents (32%) (Pinelli et al., 2017). Moreover, the discharge process may be affected by a misunderstanding of roles by providers or concerns from patients whose preferences do not match the recommendations.

Purpose and Significance

Delaying patients in the hospital longer than necessary due to the complexity of the discharge process has a negative impact on patients and the healthcare system. Prolonged hospital stays without treatment are demoralizing for people who are ready to go home (Ibrahim et al., 2022). Having a negative experience, they will reject even the necessary hospitalization, not wanting to waste their time. Moreover, patients are at risk of functional impairment, as they are stuck in a phase where they no longer receive medical care, but also cannot begin implementing medical recommendations for treatment themselves (Ibrahim et al., 2022). For example, if there is a delay in prescribing medications or if the doctor has ordered physical activity to begin, the patient will not receive proper treatment. High exposure to infectious diseases is another risk factor, as the patient spends a lot of time in waiting rooms during discharge and encounters multiple providers (Ibrahim et al., 2022). Exposure to an infectious load can adversely affect the condition of any person, especially those who have just undergone treatment.

For medical professionals, the discharge process is time-consuming and it takes up a large percentage of the patient’s treatment time. All this time, the medical system is loaded with people who are ready to be discharged and cannot accept new patients who need help. According to Ibrahim et al., the discharge process can account for up to 41.5% of the total treatment time and is often extended over 5 working days (2022). However, it is important to approach the optimization of the discharge process carefully so that it does not increase readmissions.

The Use of Care Coordination Rounds and a Departure Lounge

To improve the efficiency of the discharge process in modern medicine, an integrated approach is implemented with the use of care coordination rounds. This practice engages multidisciplinary provider teams in patient assessment, speeding up discharge time by 29% and reducing readmissions from 18.9% to 12.6% (Pierce et al., 2019). During care coordination rounds, all health workers share information about the patient’s condition and enter data into electronic records (Pierce et al., 2019). By the time of discharge, all providers are aware of the current status of the patient, and all documents are completed and in order.

Another functional element is the use of discharge or departure lounges, the main purpose of which is to triage patients to optimize the work of staff. This is particularly important in an acute care setting when the people who do not require emergency attention from medical workers are located separately from others (Barone et al., 2022). These rooms improve patient flow and increase hospital throughput (Barone et al., 2022). Discharged patients receive a safer waiting area and a more relaxed and comfortable environment with no active contact with other sick people.

Discharge Process in Nursing

Nurses play a key role in managing a patient’s discharge and are often the facilitators and communicators between all stakeholders. First, nurses complete and collect all documentation and prepare a hospital discharge summary containing all necessary instructions (Thoma & Waite, 2018). Second, they provide a link between the doctor and the patient and their family, helping to clarify all instructions for further treatment and medication (Thoma & Waite, 2018). Third, nurses care for people in departure lounges, even though they do not require special medical treatment (Thoma & Waite, 2018). Thus, it is difficult to overestimate the study of the discharge process in nursing theory, since it is the nurses who take on the greatest role in accompanying the discharge of patients.

Conclusion

Discharge planning is a complex and multidisciplinary process in which the well-coordinated work of all stakeholders is crucial. A large number of procedures to be carried out and documentation often lead to barriers and delays for the patients in the hospital for a long time, sometimes up to a week (Thoma & Waite, 2018). The main principles of establishing the discharge process are to coordinate the work of providers and optimize the patient flow. For this purpose care coordination rounds and discharge or departure lounges are used in the modern medical environment. In addition, nurses play an important role in the enrollment process as they manage the documentation and communication between healthcare providers and patients.

References

Alper, E., O’Malley, T. A., Greenwald, J., Aronson, M. D., & Park, L. (2017). Hospital discharge and readmission. UpToDate. Waltham, MA: UpToDate. Web.

Barone, M., Miller, J., Long, M. S., Buckles, J., Hain, P., Dubovsky, A., High, H., De La Cruz, P., Willians, M. & Coleman, B. (2022). Implementing a departure lounge: A strategy to improve patient flow and the discharge process. JONA: The Journal of Nursing Administration, 52(3), 129-131. Web.

Emes, M., Smith, S., Ward, S., & Smith, A. (2018). Improving the patient discharge process: Implementing actions derived from a soft systems methodology study. Health Systems (Basingstoke, England), 8(2), 117–133. Web.

Ibrahim, H., Harhara, T., Athar, S., Nair, S. C., & Kamour, A. M. (2022). Multi-disciplinary discharge coordination team to overcome discharge barriers and address the risk of delayed discharges. Risk Management and Healthcare Policy, 15, 141–149. Web.

Pierce, R. G., Amaro, C., & Jones, C. D. (2019). Improving early discharge using a team-based structure for discharge multidisciplinary rounds. Professional Case Management, 24(2), 83–89. Web.

Pinelli, V., Stuckey, H. L., & Gonzalo, J. D. (2017). Exploring challenges in the patient’s discharge process from the internal medicine service: A qualitative study of patients’ and providers’ perceptions. Journal of Interprofessional Care, 31(5), 566–574. Web.

Thoma, J. E., & Waite, M. A. (2018). Experiences of nurse case managers within a central discharge planning role of collaboration between physicians, patients and other healthcare professionals: A sociocultural qualitative study. Journal of Clinical Nursing, 27(5-6), 1198-1208. Web.

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