Nurse-led discharge planning improves quality of care
VOL: 97, ISSUE: 19, PAGE NO: 40
Nancy Brook, RN, is senior ward manager, Castle Hill Hospital, Cottingham, HullTraditionally, patients who undergo major surgery such as a hysterectomy have been admitted to hospital for five to seven days, even though many would like to return home earlier to recover in familiar surroundings.
The pilot study began by allowing E, F and G-grade nurses to organise patient discharge. The medical team is involved in key decision-making for the 48 hours after surgery. When the patient is stable and the medical assessment has been completed, key decision-making on patient care - up to and including discharge - is made by nurses. Assessments are based on nurses' professional judgement and clinical experience (Earl-Slater, 1999; Colyer and Kamath, 1999). Nurse-led discharge was piloted at the hospital and assessed, enabling criteria for early discharge to be established (Box 2). Pilot study results
The results showed a reduction in length of stay and hospital-acquired infections. All first-level nurses now undertake nurse-led discharge planning in cases where patients meet the eligibility criteria. Before nurse-led discharge planning was implemented in 1997 patients experienced delays, which are now generally avoided through prompt referral. The length of stay has been cut from an average of 2.2 days to 1.7 days. Patients having major surgery spend 3.95 days (1999-2000) in hospital compared with 4.51 days in 1997. The audit department is satisfied with the service, which has a low readmission rate. Despite a reduction in bed capacity, waiting times have been reduced from eight weeks to less than four. Conclusion
Early discharge calls for effective organisation and liaison between health care professionals, a view supported by the Nuffield Institute for Health (Godfrey and More, 1996). Nurse-led discharge meets service demands, improves the quality of care, provides a more efficient pathway for discharge planning and increases patient satisfaction. However, successful nurse-led discharge must be backed up with a concise and regularly updated policy.