Long Term Patients in an Acute Care Setting: A Proactive Approach to Complex Discharge Barriers Tracy Pencar MSN, ACM-RN and Leah Hochstetler BSN, RN-BC Background A 24 Bed neuro medical surgical unit experiences patients who are difficult to care for and to discharge due to a variety of complex discharge barriers. – As a Result: • Staff Injuries • Emotionally/physically taxing • Frustration • Burnout • Inconsistent care • Disproportionate use of resources • Inappropriate level of care for the patient.
Method This project includes a multiphase approach •
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The first phase of this project included: – The development and implementation of a complex discharge trigger tool utilizing the PDCA method – Education and training were provided for direct care nurses. The second phase involved: – Hardwiring a consistent process for use of the Complex Discharge Barrier Trigger Tool using the Six Sigma Process Improvement – Increased collaboration of clinical nursing and care management
The literature revealed a correlation between patient characteristics and a delay in discharges due to their complexities • • • •
The results from implementing and utilizing this tool during the first two phases included: Improvement in nurse’s ability to identify patients who are at risk of delayed/complex discharge from 77% of staff to 100% Increase in the utilization of care conferences - from 82% to 100% of clinical staff caring for patients who have had a care conference Promotion of interdisciplinary team collaboration on patients with complex discharges with clinical staff increase from 61% to 82% in collaboration and Care management team from 72% to 81% In some cases, decrease the length of stay for patients with complex discharge needs
Staff able to identify patients at risk having a delayed discharg leading to a prolong hospital stay>9 days
Complex Medical Needs Behavioral Financial issues Family Dynamics
I feel there is a process to identify complex patients discharge needs early in the admission
120%
100%
100%
80%
80%
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60%
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40% 20%
20%
0%
0% Disagree 2/13-3/14/2017
Identified a need for a clear process to identify the patients with complex discharge barriers early and proactively The Complex Discharge Trigger Tool was created to identify patients with potential barriers to discharge for: – Empowerment of clinical staff to proactively intervene and collaborate with care management – Early Identification of a need for a patient care conference • Enabled nursing staff to revise a specific care plan and approach to patient care • Decreased the patient behaviors and discharge barriers. • Allowed clinical staff to help smooth the transition to the patient’s next level of care.
Outcomes
Agree 8/31/-9/21/2018
Disagree
1/14-2/14/2019
2/17-3/8/18
It is easy to collaborate with SW//CM regarding discharge plansfor patient with complex discharge barriers
8/31/-9/21/2018
I feel comfortable collaboratine with Neuro Med Surg RN regarding discharge plans for patientwith complex discharge barriers
100%
Complex Discharge Barrier Tool and Process Flow
Agree
100%
80%
80%
60%
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40%
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20%
0%
0% Disagree 2/17-3/8/18
Neutral
Agree
8/31/-9/21/2018
1/14-2/14/2019
Disagree 2/17-3/8/18
Neutral
Agree
8/31/-9/21/2018
Implications to Practice Purpose The purpose of this project was • Develop a structure to facilitate an early and proactive approach to identify and address the needs of patients with complex discharge barriers. • Increase staff collaboration. • Lay the ground work for utilizing care conferences.
UCHealth Poudre Valley Hospital
The use of the Complex Discharge Barrier tool promotes: – – – –
Improved interdisciplinary communication Promotes the use of patient care conferences Empowers Clinical staff Proactively identifies patients who are at risk for delay in discharges despite being medically ready – Lays the pathway for proactively and intentionally addressing patient discharge barriers. – Provides a format for creative patient centered problem solving