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theses

Patient flow is a safety issue that requires attention in healthcare. In recent years, the Institute for Healthcare Improvement (IHI) and the Joint Commission have identified patient flow as a patient safety issue. Providing quality, safe and efficient patient care is a gold standard for healthcare organizations. To provide quality patient care in healthcare, organizations must identify patient safety areas that need improvement and develop strategies to solve identified problems. The admission and discharge process which are two components of patient flow are labor and time intensive. A disjoint in the patient flow process can result in patient dissatisfaction. Use of a discharge/admission nurse is one recommended way to improve the patient flow process. One of the available metrics that the Joint Commission uses to appraise an organization's leadership, safety and process improvement culture is re-designation of processes to minimize waste.
Purpose: This project evaluated the effectiveness of utilizing a discharge/admission nurse to optimize patient flow and patient satisfaction.
Methodology: This project took place on a 29-bed telemetry unit in a community hospital in Hudson county, NJ. A night shift RN position was repurposed to accommodate the discharge/admission nurse position. A pre and post patient flow and patient satisfaction data were collected and analyzed for 6months prior to and after the start of the discharge/admission nurse. The shift hours of the discharge/admission nurse were redesigned to match the work intensity of the unit.
Results: Analysis of data demonstrated surprising results in the outcomes that were measured. Results showed a statistically significant difference in the following outcomes: number of admission per month, minutes spent on discharges, patient satisfaction scores in the discharge information and patient satisfaction scores on the nurse communication domains. There was no statistically significant difference noted in the number of discharges and minutes spent on admission, pre and post the start of the discharge/admission nurse. A tremendous decrease in the number of minutes spent on discharges was noted. This decrease in discharge minutes did not translate into increased patient satisfaction scores rather there was increased patient dissatisfaction.
Implications for Practice: This study adds and strengthens the idea of utilizing a discharge/admission nurse to facilitate and optimize patient flow. This project needs more time for modification and improvement of the process. There are multiple implications in clinical practice, quality and safety for the healthcare system. Aspects for future research include but is not limited to evaluating the utilization of one discharge/admission nurse vs a team in the optimization of patient flow and patient satisfaction.

ETD_9947

DNP

Includes bibliographical references

doi:10.7282/t3-93w1-cp36

ETD doctoral

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