Nurse led discharge: improving efficiency, safely

Abstract

Purpose – The purpose of this paper is to demonstrate that nurse led discharge (NLD) could improve the efficiency of simple discharges from a short stay surgical ward without compromising patient safety. Design/methodology/approach – A protocol for NLD was designed and implemented. Introduction of the protocol was audited and re-audited prospectively. Findings – Introduction of the nurse led discharge protocol significantly reduced the rate of delayed discharge (p>0.001). The protocol successfully identified all patients for whom a NLD would be inappropriate and no patients discharged by the nursing team were re-admitted. Research limitations/implications – No formal measure of staff and patient satisfaction with the new protocol was performed. Practical implications – The nursing team are now able to more effectively manage patient flow through the short stay surgical ward. Mismatch between demand for beds and capacity has reduced. Social implications – Patient experience has been improved by the release of time to care for our nurses and the elimination of unnecessary delay in discharge. Originality/value – Formal protocol driven NLD can be a safe way of improving efficiency in patient flow. This pattern of discharge could be applied in many hospital systems.

A Systematic Review of Criteria-Led Patient Discharge

“…Four articles (n = 15) provided empirical data regarding the safety of using criteria to guide patient discharge. [18][19][20][21] Safety measures were described as follows: health care team agreement regarding clinical CLD protocols, staff training/preparation for CLD, patient information about CLD, patient follow-up (postdischarge), and monitoring patient readmissions following CLD. None of the studies found that readmission rates for patients discharged using CLD were increased.…”

“…Bowen et al 19 aimed to improve the efficiency of simple discharges without compromising patient safety through a protocol developed by the health care team. This enabled the discharge of patients by nurses without further review of a physician.…”

“…Education to the support staff was a major feature throughout the literature to execute safe practice for discharge. [18][19][20][21][22][23] Measures to monitor outcomes related to safety hospital-wide were only described by Lees and Field 23 by using an "electronic dashboard" where data were collated and reported to the hospital board of directors.…”

“…25 Although the literature was reviewed for patient experience with CLD, staff perspectives were also evident. Two aspects emerged, namely, empowerment of nursing staff 11,19 and overall work satisfaction. [20][21][22] Staff satisfaction improved following the introduction of CLD, 22 which was described as being "useful, user friendly, and easy to understand and apply."…”

“…20 Nurse-led discharge was also noted to reduce demands on surgical residents and provided time for physicians to take part in training opportunities instead. 19…”