Publication Date
Spring 4-16-2025
College
Gordon E. Inman College of Nursing
Department
Nursing, School of
Student Level
Graduate
Faculty Advisor
Laura Gray
SPARK Session
10:15 a.m. to 11:45 a.m.
Presentation Type
Poster
Summary
Abstract
Title:
Increasing Discharge Efficiency in a Joint Replacement Unit: A Quality Improvement Project
Background:
Patient discharge is a complex process. Lack of discharge expectations, standardized discharge instructions, and interprofessional communication create discharge barriers leading to an increase in post-operative length-of-stay and 30-day readmissions. Discharge delays disrupt unit workflow and increase staff workload. Readmissions within 30 days of discharge are associated with increased hospital costs and lower patient satisfaction.
SMART Aim:
By December 1, 2024, we aimed to reduce the average post-operative length-of-stay for elective joint replacement outpatients from 14.5 hours to 12 hours by implementing a standardized discharge-navigator tool to be utilized by the nursing staff.
Design:
The project implemented the IHI Model for Improvement using Plan-Do-Study-Act (PDSA) cycles.
PDSA Cycle 1:
- Education: The monthly unit education PowerPoint presentation introduced the project to the nursing staff. Attended monthly virtual charge nurse and nursing staff conferences to explain the project's purpose and help answer any questions.
- Leadership engagement: Introduced the discharge-navigator tool to the unit nursing staff and demonstrated how to complete the form. Informally interviewed staff members for discharge-navigator tool improvement.
- Data collection: Collected interprofessional satisfaction surveys to revise the discharge-navigator tool for PDSA cycle 2. Collected and logged the number of completed discharge-navigator tools weekly. Collected weekly post-op length-of-stay and weekly 30-day readmission data.
PDSA Cycle 2:
- Tool revision: Incorporated feedback from satisfaction survey and from informal staff interviews to improve uptake of discharge-navigator tool.
- Leadership engagement: Introduced revised discharge-navigator tool and worked alongside nursing staff to champion the tool.
- Data collection: Collected and logged completed discharge-navigator weekly. Collected weekly post-operative length-of-stay and weekly 30-day readmission data. Collected post-project survey to assess nursing staff satisfaction.
Measures:
- Outcome Measure: Weekly average post-operative length-of-stay time.
- Process Measure: Weekly number of completed discharge-navigator tools.
- Balancing Measures: Interprofessional staff satisfaction and weekly average 30-day readmissions.
Results:
- Outcome Measure Findings: The average length of stay for joint replacement outpatients was reduced from 14 hours and 52 minutes to 14 hours and eight minutes. This marks a 44-minute reduction during the project’s implementation phase, excluding Thanksgiving week.
- Process Measure Findings: 162 discharge-navigator tools were collected. The nursing staff completed one tool for every three outpatient cases.
- Balancing Measure Findings: The project notes a 36% reduction in the average weekly outpatient 30-day readmission rate. Post-project satisfaction survey revealed that 11 out of 11 nurses were very satisfied or satisfied with the evolution of the discharge-navigator tool. One nurse stated, "It was a very good tool and helpful in navigating patient needs. It was very easy to find information when giving a report.”
Conclusions:
The evidence-based discharge-navigator tool reduced post-operative length-of-stay without compromising 30-day readmission rates or staff satisfaction. This project demonstrates that implementing a standardized tool can increase discharge efficiency.
Implications for Practice:
It is essential to continue evaluating the tool's efficacy in improving patient outcomes and staff satisfaction. Education and implementation of the discharge navigator tool improved patient outcomes and unit workflow. Successful integration of the discharge navigator tool into the electronic health record could further increase tool uptake and sustainability.
Recommended Citation
Fabre-Rivera, Mario O., "Increasing Discharge Efficiency in a Joint Replacement Unit: A Quality Improvement Project" (2025). SPARK Symposium Presentations. 385.
https://repository.belmont.edu/spark_presentations/385
