Creation of a Discharge Nurse Position on the Neuroscience Progressive Care Unit
Rationale/Background: Follow-up calls after discharge have been show to decrease readmission rates when in concert with comprehensive discharge planning prior to discharge. (Cynthia Locker MS, 2011) (Harrison, 2011). While readmission rates did not appear to be a problem at an average of 2-5% on our unit, we knew that it was a potential problem and could impact our reimbursement rates. In addition, there is now money available from CMS for the top hospital performers depending on the HCAHP scores. Telephone calls can also increase patient satisfaction scores (Eyal Braun, 2009). 5 South Neuroscience’s HCAHP and Press Ganey Scores were below the hospital average. Our goal was to prevent readmissions when possible and increase patient satisfaction and prevent unintended complications for the patients we discharge home.
Methods: In November of 2012, 5 South implemented a discharge nurse position for our unit. In addition to the development of a comprehensive discharge plan for each discharge, we wanted the discharge nurse to track core measures and provide core measure education when applicable, make follow up calls to ensure the transition of care was going smoothly at home and serve as a resource nurse on the floor. The nurses selected for the discharge nurse position were selected because of their clinical expertise, adaptability and pleasantness.
Outcomes: We measured five patient satisfaction items to determine if the discharge nurse impacted patient satisfaction. Both the Press Ganey and HCAHPS scores increased from an average as low as 72% to as high average as high as 86% after implementation of the nurse discharge program. There were also several anecdotal results of near misses and increased satisfaction of staff and faculty. During the summer of 2014 the discharge nurse was often needed to staff the floor and unable to function as the discharge nurse. The data for those three months actually did not show any significant changes in patient satisfaction scores, but the staff did reported decreased satisfaction and, our core measures scores for stroke education decreased enough to threaten our status as a primary stroke center. This demonstrated how crucial the discharge nurse’s roles were in core measure education and documentation. 5 South found that the program was so successful that we have added another discharge nurse to provide 7 days/week coverage.
Conclusions: The addition of a discharge nurse position to 5 South is crucial to maintain/improve patient satisfaction, and prevent unintended complications in this incredibly vulnerable population resulting in readmission to the hospital. While all nurses learn to discharge patients, this expertise a nurse can give to a patient can be the deciding factor in how well a patient does when he goes home. This pilot project shows how important a dedicated discharge nurse education and instructions are to the patient’s safe transition home from the hospital.