riding the wave to a new personalized discharge : professional issues
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universal protocol.This was felt to be directly relatedto the ease of access of the software and abilityto do real-time charting in the operating room. Adecrease in postsurgical complication was alsonoted.Continued evaluation and quality monitoring
will further determine sustained quality and practiceimprovements.
REFERENCESAnonymous. (2008). From glimmer to reality: The adoption of innovation
in healthcare. Health Data Management, 16(8), 8-12.
Bates, D. W., & Gawande, A. A. (2003). Improving safety with information
technology. New England Journal of Medicine, 348(25), 2526-
Gardezi, F., Lingard, L., Espin, S.,Whyte, S., Orser, B., & Baker, G. R. (2009).
Silence, power and communication in the operating room. Journal
of Advanced Nursing, 65(7),1390-1399.
Institute of Medicine. (1999). To err is human: Building a safer health sys-
tem.Washington, DC: National Academy Press.
Leape, L. L., & Berwick, D. M. (2005). Five years after to err is human. Jour-
nal of the American Medical Association, 293(19), 2384-2390.
Lewin, K. (1952). Field theory in social science. London: Routledge &
Riding the Wave to a New Personalized
The Family Centered Care Unit (FCC-3) at InovaFairfax Hospital (IFH) experienced a sharp de-cline in patient satisfaction and a few near-missedand missed safety events in the third quarter of2008. After reviewing all of the impacting factors, a
Discharge Coordinator Program (DCP) was createdto increase patient satisfaction and ensure patientsafety. The DCP uses a nurse whose main objec-tives are to provide an individualized plan of carefor each patient, coordinate with the primary nurseto reallocate patient assignment, and to check allcharts to ensure patient safety needs have beenaddressed prior to discharge.
Every patient is given a teaching plan check list, andthey are instructed to pick topics that they feel arerelevant to their discharge that are reviewed with thefamily. The Discharge Coordinator (DC) performspostdischarge phone calls to gather timely feedbackfor practice changes.The primary RN is able to utilizeher time with the patient more eectively without in-
creasing the cost of manpower. Patients and familiesare more satised when education is tailored to theirneeds. In a unit with a high patient turnover rate,the streamlined DCP promotes the eectiveness ofpatient learning and improves the eciency of work-force management.
This discharge process has armed patients with aplethora of relevant information that addresses theirindividual learning needs. The double-checkingsystem ensures that no steps are missed in patient
safety. The postdischarge phone call provides in-valuable data and has led to a renement in teamsafety rounding practices as well as alternate edu-cation methods. After these phone calls, wefound that the Spanish speaking patients left thehospital with several unanswered potentially dan-gerous questions. This raised concerns, and a
Spanish speaking discharge class evolved. As theprogram has matured, it has been standardizedand expanded to all FCC units to provide service7 days/week for English and Spanish speakingpatients.
The DCP is useful to units with high patient turnoverrates. By eective rearrangement of the nursingworkforce, this program allows nurses to spendmore time with their patients, ensures the quality ofpatient care, and increases patient satisfaction and
patient safety. Returning patients have expressedtheir appreciation for this change. Physicians haveembraced the DCP and seek the coordinators forinformation. The wait for discharge clearance hasdecreased, thereby decreasing length of stay andspending of budgeted supplies. The preliminarydata show an improvement in patient satisfactionsurvey results. The excellence ranking has risenfrom the 66.6 to 81.3 percentile in two quarters sinceinception.There have been no serious safety eventsnoted, and timely discharges have been observed.
The program is currently being piloted at anotherInova hospital on the postpartum unit and on twoother short-stay medical/surgical units.
Jennifer O. Effah, RN, BSN,
Family Centered Care, Inova
Fairfax Hopsital, Falls Church,
Cynthia K. Dowd, RN, Family
Centered Care, Inova Fairfax
Hopsital, Falls Church, VA
Corinne Peterson, RN, BSN,
Family Centered Care, Inova
Fairfax Hospital, Falls Church,
Patricia Schmehl, RN, MSN,
Inova Fairfax Hospital, Falls
S56 JOGNN, 39, S48-S84; 2010. DOI: 10.1111/j.1552-6909.2010.01121.x http://jognn.awhonn.org
I N N O V A T I V E P R O G R A M SProceedings of the 2010 AWHONN Annual Convention