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Nurses are working hard to improve the problem of delayed hospital discharges through quality improvement initiatives, but it remains a major challenge. The initiatives include holding discharge communication huddles, creating patient pathway programs to facilitate discharge, increasing accessibility to diagnostic services over the weekend, allowing nurses to place discharge orders according to specific criteria, and hosting weekly initiative meetings for updates on the progress towards the goal (Cadel et al., 2021). These interventions had positive results, decreasing the use of hospital resources on those who were ready to be discharged. The data trends suggest that the interventions that include the entire interdisciplinary team were more impactful than ones that were individual to nurses (Cadel et al., 2021).

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Title: Nursing Issues in Interprofessional Collaboration: The Discharge Process

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Title: Nursing Issues in Interprofessional Collaboration: The Discharge Process

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By: Grace Bradley

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There are certain challenges to participation by the nurse, including time constraints, the need for reciprocation in communication by other team members, and fears of judgement within the social hierarchy of the unit. Time constraints must be considered in every nursing quality improvement project. Nurses have busy daily schedules, so improvement projects must not take an excessive amount of time. There is also a need for the entire interprofessional team to be involved. The nurse can work to proactively communicate with other team members, but these efforts must be reciprocated with prompt responses. Nurses may also fear judgment on the unit. Reaching out to providers and those considered higher than them on the unit’s social hierarchy to request discharge orders can be intimidating. It is important for the management team to promote an atmosphere of respect so that the nurses feel comfortable reaching out to the providers with discharge requests.

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The first piece of literature discusses which patient populations are most at risk to have complications to their discharge plan, and how using electronic health records can help to streamline the discharge process. The patients who are at greatest risk for a complicated discharge are those admitted for life-altering events, such as stroke, heart attack, or major surgery, as well as those diagnosed with psychiatric disorders (Patel & Bechmann, 2023). These patients need a significant amount of education about lifestyle changes, medication information, and potential complications. They also require coordination with other members of the interdisciplinary healthcare team including therapies, nutrition services, and home health.

Many of the issues with discharge planning involve a lack of communication (Patel & Bechmann, 2023). This article discusses how the electronic health record simplifies and streamlines communication between members of the interdisciplinary team. There are also built-in patient education options within the electronic health record (Patel & Bechmann, 2023). This means that digital education bundles can be assigned for the patients by the provider instead of having to manually write out discharge education themselves. Nurses can also access this educational material and print it for their patients (Patel & Bechmann, 2023).

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The second article is focused on the importance of ensuring that patients understand their discharge plan and education when they are discharged from the emergency department. The authors' research found that written discharge summaries were often too lengthy and confusing for patients to fully understand (DeSai et al., 2021). Their initial survey found that 0% of patients had an adequate understanding of their discharge summary and instructions, with 80% of patients not understanding their prescribed medication dosage and duration. Interactions between providers and patients in regard to discharge were only around 1 minute long on average (DeSai et al., 2021). These factors emphasize the importance of nurses meticulously reviewing instructions with patients before they are discharged. The provider must collaborate with the nurse to ensure that all information is covered.

This study provided one method that could improve the discharge process in the hospital. Specifically, the researchers studied the effects of using a simplified education sheet. They found that once the simplified sheet was implemented, 73% of patients received satisfactory discharge instruction (DeSai et al., 2021). This sheet would also help with the interdisciplinary issues, as it would take less time to review with the patient, thereby increasing the likelihood of the doctor, nurse, or case manager reviewing it with them. This method relates to the interdisciplinary team because each individual plays a role in implementing it. The manager on the unit must be involved and standardize the simplified sheet. The providers will fill out the sheet with discharge instructions, and the nurses will review it with the patient to ensure that they understand.

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The final article is a review that looks at the causes of delayed discharge from the hospital. The author mentions that there is no firm, cohesive agreement on the cause, but trends are examined (Abdelhalim et al., 2024). They found that frail or elderly patients who are dependent on others for their daily care are at a high risk for delayed hospital discharge. This is likely because those who are dependent on others for their daily care are more likely to need admission to a facility following discharge from the hospital.

One cause of delayed hospital discharge was delayed creation of a discharge plan. It was recommended that the discharge plan is started shortly after the patient is admitted to the hospital, rather than shortly before they leave (Abdelhalim et al., 2024). This allows the plan to be personalized through interprofessional communication and adjusted as needed to promote on-time discharges. It was also discovered that many patients report feeling unsupported in their discharge conversations (Abdelhalim et al., 2024). This can delay discharge through Medicare appeals when the patient does not feel ready to leave the hospital.

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Abdelhalim, A., Zargoush, M., Archer, N., & Roham, M. (2024). Decoding the persistence of delayed hospital discharge: An in-depth scoping review and insights from two decades. Health expectations : an international journal of public participation in health care and health policy, 27(2), e14050. https://doi.org/10.1111/hex.14050

Cadel, L., Guilcher, S. J. T., Kokorelias, K. M., Sutherland, J., Glasby, J., Kiran, T., & Kuluski, K. (2021). Initiatives for improving delayed discharge from a hospital setting: a scoping review. BMJ open, 11(2), e044291. https://doi.org/10.1136/bmjopen-2020-044291

DeSai, C., Janowiak, K., Secheli, B., Phelps, E., McDonald, S., Reed, G., & Blomkalns, A. (2021). Empowering patients: simplifying discharge instructions. BMJ open quality, 10(3), e001419. https://doi.org/10.1136/bmjoq-2021-001419

Patel, P., & Bechmann, S. (2023, April 3). Discharge planning. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK557819/

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The nurse’s role in resolving the problem of discharge planning and education is very important. The bedside nurse is typically responsible for coordinating the majority of the interprofessional collaboration because they spend the most time with the patient. The nurse must ensure that orders are placed and initiated promptly so that patient care and discharge are not delayed. Nurses should reach out to the providers and case managers in advance to facilitate a smooth transition off the unit. The case managers should collaborate with the nurse and patient to arrange home care services, therapy, and admission to facilities, as needed. This proactive involvement by the nurse will help to decrease delays in discharge, improving patient satisfaction and reducing the impact on the hospital system.

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Problems with consistent communication during discharge planning impact the entire healthcare team and family of the patient, but the primary person impacted by these issues is the patient themselves. Their discharge date could be impacted, delaying access to important resources and care outside of the unit. The family of the patient may be affected if discharge is delayed through unnecessary disruptions to their work schedules and personal plans.

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Three recommendations to improve the nurse’s involvement with the issue of delayed hospital discharge are to refine the electronic health record, promote nurse driven discharges, and post contact information for team members at all nurse's stations. The electronic health record could be automated with pop ups to remind the nurse to consider discharge once the patient has met certain criteria. These reminders could help speed up the initiation of the discharge process for each patient. They could include check boxes reminding the nurse to provide the patient with discharge education, as well as to contact necessary team members such as case management. As mentioned earlier, the promotion of nurse driven discharges would help to streamline the discharge process. These work by allowing nurses to discharge patients when they meet certain criteria supplied by the provider. This would encourage weekend and evening discharges, so that patients are not waiting for the provider to be in the hospital to be discharged. Posting the pager and phone numbers of the providers, case managers, and therapists would help promote interprofessional communication. Nurses would be able to call or page team members with questions when needed to facilitate discharge planning.

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The first curricular concept that will help me in my professional practice in the context of the issue of delayed discharge and interprofessional collaboration is the concept of delegation. This concept is important because it enables each member of the interdisciplinary team to engage with the patient through their appropriate role. It will help me as I transition into positions of leadership and delegate tasks to those working with me. I feel that I will be able to transition to practice as a confident and capable nurse leader who trusts her team, maintains responsibility, and prioritizes patient outcomes.

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The second curricular concept I will discuss is the concept of professionalism. Professionalism is important in discharging patients, as education should be written and provided in a professional and consistent manner. Every member of the interdisciplinary team should be treated with professionalism and respect during interactions, meetings, and when sharing concerns or requests. Being a leader in nursing is not only about having a leadership position, but it is about modeling professional behavior and respectfully bringing quality improvement recommendations to the attention of the team. I feel as though I am prepared to step into this role as a professional nurse leader.