Enhancing the Discharge Process Step by Step

By Ann Malec, MS, RN, ACNP


Eric Nolan, MD, and Katlynn Kelley, BSN, RN, CMSRN, discuss a patient’s anticipated discharge date to keep communication open throughout the hospital stay. As the saying goes, "A picture is worth a thousand words." I vividly recall the "picture" of a patient's family member walking up to the nurses' station. The man, visibly distraught, said, "We were told we could leave six hours ago. I just want to take my wife home. We have hours to drive! Why can't my wife be discharged? Can someone please help us?"


This wasn't the "picture" we wanted patients to take home. Additionally, our Press Ganey data also reinforced that this picture was not the experience of just one patient, but of many patients. In fact, satisfaction data revealed that only half of our patients were satisfied with their discharge experience. As an organization committed to a core goal to provide a patient and family experience of compassion and excellent clinical quality, it was time to get the paint brush out and paint a new picture.


We set out to create an enhanced discharge process and we tackled it, step by step. The "artists," otherwise known as the interdisciplinary team, which also included patient and family advisors, gathered together to problem solve new approaches to the process. Over the course of several months, the team worked diligently to outline a structure to improve the process. The main purpose was to coordinate the time of discharge with the patient, family and interdisciplinary team to avoid confusion, fragmentation and frustration.


The new process now includes documenting an anticipated discharge date and a confirmed discharge date and time on the patient's whiteboard and the Discharge Status Board in Health Link, the electronic health record. The anticipated discharge date is intended to provide an estimated date of discharge. Because several factors may influence this date, daily discussions between the interdisciplinary team and the patient and family during bedside rounds, are of the utmost importance.


These daily discussions also help to narrow down an actual confirmed discharge date and time. Because there are so many steps involved in the discharge process, early planning is critical to avoiding fragmentation and frustration for everyone involved. Most importantly, this new way of planning and collaborating with patients and families supports the true essence of patient- and family-centered care.


Initial efforts to improve the patient experience around the discharge process are yielding positive results. While this significant change in culture will take time, the percentage of patients with a confirmed discharge date and time is now up to 68 percent since the go live of March 31, 2014. Likewise, initial Press Ganey satisfaction data also demonstrates improvement. We are hopeful that ongoing improvement will paint a "new picture" that will leave a lasting positive impression on the patients and families we serve.