Designated Discharge Resource RN Improves Flow at Unit Level Gracie Fisher BSN RN CPN
RESULTS
PURPOSE In the face of rising hospital census and severe capacity issues, Care Coordination and Acute Care Nursing collaborated to develop a pilot program of designated “Discharge RNs.” Our question was: Does having a designated Discharge RN improve unit flow?
(6/6/2018 through January 2019)
BACKGROUND • Rapidly rising hospital census • Capacity issues (consistently >100%) • Lack of inpatient beds • Inadequate nurse staffing • “No cancelled surgeries” policy enforced May 2018 • Diversions strongly discouraged
METHOD Care Coordination Department and Acute Care Nursing Leadership selected four experienced acute care RNs (2 from the surgical unit and 2 from the medical unit) to work 0700-1530 on Wednesdays, Thursdays, Fridays as “Discharge RNs.” For this poster I have chosen to focus on the data from my home unit (RC5 Surgical Unit) which consistently experiences high rates of daily patient turnover.
PILOT DATES • ACTIVE PILOT: 6/6/18 through 9/1/18 • POST PILOT: 9/1/18 through January 2019
MEDIAN DISCHARGE TIMES PRE Pilot
1408
(June 2017-June 2018)
Pilot Control
1410
(Mondays & Tuesdays)
Pilot Active
1311
(Wed Thur Fri)
Post Pilot Control
1345
(Mondays & Tuesdays)
PILOT GOALS • Identify barriers in the discharge process • Generate ideas for how to overcome challenges within our current system • Move the median discharge time one hour earlier for patients identified by teams as medically ready for discharge.
DC RN RESPONSIBILITIES • Rather than receiving a standard patient assignment, the Charge RN provides a list of the potentially discharging patients on which to focus. • DC RNs collaborate with bedside RNs to identify how they can assist in facilitating a comprehensive, efficient, timely discharge. • DC RNs serve as a multidisciplinary liaison between RNs, pharmacists, providers, ancillary services, families, patients, etc. • DC RNs strive to identify barriers to discharge, brainstorm ideas for improvement and collect relevant data.
Post Pilot Active
1328
(Wed Thur Fri)
CONCLUSION • Objective data demonstrates that we met our goal of shifting the median discharge time one hour earlier during the pilot phase. After the pilot, the “control days” (sans DC RN) also demonstrated an earlier median discharge time. • Subjective data reveals profound hospital wide resistance to timely discharge. Improvement projects will evolve as issues and barriers are revealed and escalated. Without the DC RN Pilot, many of these barriers would not have been exposed. • Although the pilot has concluded, our team has decided to continue utilizing the role of DC RN on the medical and surgical units. We have streamlined our data collection system and we maintain a primary goal of providing patients and caregivers with a comprehensive discharge plan while preventing delays in discharge, supporting efficient use of hospital beds by discharging patients as soon as medically ready.