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How Magnet Hospitals Handle Discharge Care

Created Nov 03 2015, 07:00 PM by Lippincott Solutions
  • Care transitions
  • readmission
  • transitions
  • ANCC Magnet
  • JONA
  • discharge care
  • Journal of Nursing Administration
  • clinical excellence
  • ANCC

Wednesday, November 4, 2015
How Magnet Hospitals Handle Discharge Care

In an attempt to reduce readmissions, hospitals are working hard to better prepare patients for the transition from hospital to home. But what does that effort actually look like from hospital to hospital? From unit to unit?

To gain an understanding of how “the best” hospitals in the United States are handling discharge care, a group of researchers surveyed 64 units at 32 Magnet-designated facilities to learn the nitty gritty of their discharge processes: What did they include? Who did what? How were the patients involved?

A report detailing their findings appears in the October issue of The Journal of Nursing Administration.

“While it was evident that there are substantial efforts being focused on readmission reduction initiatives at the hospital and unit levels, discharge preparation processes and roles varied widely even between units in the same hospital,” the researchers write. “There was no singular model for discharge preparation; however, common patterns in discharge planning, discharge coordination, and discharge teaching were evident.”

Here are a few key discoveries the researchers made.

Magnet hospitals are using established programs for discharge transition, but they’re adapting them.

 “Many hospitals are participating in nationally disseminated discharge transition coordination initiatives such as the Care Transitions Model and Project RED,” researchers report, “but many are customizing and combining aspects of these models into their unique discharge models of care.”

Among nationally known discharge transition programs, the most popular were:

  • the Care Transition Model by Eric Coleman, MD, MPH (used by 17.2% of the units)
  • the Centers for Medicare & Medicaid Services Care Transition Project: Interventions to Reduce Acute Care Transfers (9.4%)
  • Project RED (Re-Engineered Discharge) (7.8%)
  • BOOST (Better Outcomes for Older Adults through Safe Transitions) (7.8%)
  • the Institute for Healthcare Improvement/American College of Cardiology Hospital to Home model (7.8%).

In addition, nearly 19% of units used programs that were part of local or regional collaborative initiatives. About 28% report using discharge screening tools that were altered by the hospital or entirely homegrown.

Discharge prep responsibilities are spread among several professionals, but RNs are leading the process.

Some 97% of the units reported more than one discharge planning role. Most commonly, an RN case manager dedicated to the unit took the lead. The discharging staff nurse assigned to the patient had the lead responsibility for more than a quarter of the units. Social workers also handled discharge planning, although they sometimes worked across more than one unit at a time.

“While multiple perspectives are important, there is potential duplication of efforts in this approach,” the researchers observe.

More than three-quarters of units hold daily discharge rounds, but less than a third include the patient and family in them.

Nearly 83% of units conducted daily discharge rounds. The most frequent participants were nursing, medicine and pharmacy. Interestingly, the least frequent participants were patients and family members—“despite,” the researchers point out, “the current emphasis on patient engagement.”

More than two-thirds follow up with patients by phone, but most mainly want to know if patients were satisfied with their stay.

More than 67% of the units made follow-up calls to patients after discharge. About 30% call every patient at home. The majority of units said the main reason for the follow-up call was to evaluate patient satisfaction. Reinforcing the plan of care was the main topic for just 41% of the units.

“The value of follow-up call programs, especially made by nurses, should be maximized to support discharge transition and readmission risk efforts by focusing on reinforcement of teaching and follow-up plan care and assessment of postdischarge continuing care needs,” the researchers advise, “rather than evaluation of patient satisfaction.”

Not Best Practices, But What ‘The Best’ Do

The researchers note that the study was not intended to identify best practices for the discharge preparation process. Rather, it aims to unveil what Magnet-level hospitals are doing as part of their discharge prep.

Are you surprised by what the study found? How does your unit handle discharge prep?  Leave us a comment below.  

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