An evaluation of a nurse led unit: an action research study

This study is an exemplar of working in a participatory way with members of the public and health and social care practitioners as co-researchers. A Nurse Consultant Older People working in a nurse-led bed, intermediate care facility in a community hospital acted as joint project lead with an academic researcher. From the outset, members of the public were part of a team of 16 individuals who agreed an evaluation focus and were involved in all stages of the research process from design through to dissemination. An extensive evaluation reflecting all these stakeholders’ preferences was undertaken. Methods included research and audit including: patient and carer satisfaction questionnaire surveys, individual interviews with patients, carers and staff, staff surveys, graffiti board, suggestion box, first impressions questionnaire, patient tracking and a bed census. A key aim of the study has been capacity building of the research team members which has also been evaluated. In terms of impact, the co-researchers have developed research skills and knowledge, grown in confidence, developed in ways that have impacted elsewhere in their lives, developed posters, presented at conferences and gained a better understanding of the NHS. The evaluation itself has provided useful information on the processes and outcomes of intermediate care on the ward which was used to further improve the service

Evaluation of the organisation and delivery of patient-centred acute nursing care

In 2002, a team of researchers from the School of Nursing, University of Salford were commissioned by Bolton Hospitals NHS Trust to evaluate the delivery and organisation of patient-centred nursing care across the acute nursing wards within the Royal Bolton Hospital. The key driver for the commissioning of this study arose from two serious untoward incidents that occurred in the year 2000. Following investigation of both these events the Director of Nursing in post at that time believed that poor organisation and delivery of care may have been a contributory factor. Senior nurses in the Trust had also expressed their concern that care may not be organised in a way that made best use of the skills available

Nurses’ Perception of Discharging the Medically Complex Pediatric Patient

The purpose of this study is to query the nurses for their perceptions of the barriers and facilitators of discharging medically complex pediatric patients from a freestanding children’s hospital in central California. Using a mixed methods research design via an online survey, 90 nurses identified 3 distinct themes that act as barriers. Those barriers include: 1) knowing the plan of care, 2) time, and 3) disposition of the family. Several implications for improving the discharge process for medically complex patients and overcoming the identified barriers include strategies to improve multidisciplinary communication, implementation of a Family Learning Center, use of video interpreters when in-person interpreters are not available, and respect for discharge readiness. Recognizing and implementing the appropriate interventions based on nurses’ feedback have the potential to improve quality and patient safety

Foodservice in hospital: development of a theoretical model for patient experience and satisfaction using one hospital in the UK National Health Service as a case study

Hospital foodservice does not operate in isolation but requires the cooperation and integration of several disciplines to provide the ultimate patient experience. The objective of this research was to explore the antecedents to patient satisfaction and experience, including the service element. Accordingly, focus groups were conducted with doctors (n = 4), nurses (n = 5), ward hostesses (n = 3) and patients together with their visitors (n = 10), while open-ended interviews were conducted with the foodservice manager, facilities manager, chief dietitian, orthopaedic ward dietitian and chief pharmacist. Themes centred on ‘patients’, ‘foodservice’ and ‘mealtimes’, and results show that food qualities, particularly temperature and texture, are important factors impinging on patient satisfaction, and the trolley system of delivery is an acceptable style of service. Service predisposition demonstrates little relevance to patient satisfaction towards overall meal enjoyment. A theoretical model has been developed that identifies hospital foodservice in a cyclic relationship with the community primary healthcare team

Improving patient safety during the emergency department discharge process with the use of two patient identifiers.

Nurses are not always confirming two patient identifiers while conducting a patient discharge, resulting in patient identification errors. This problem has been shown to significantly affect patient safety and satisfaction, decreasing both when errors are made. These errors also have heavy financial and legal consequences on the affected facility and on the discharging nurses, warranting a need for improvement. The purpose of this quality improvement project was to decrease patient-identification errors at discharge by increasing nurse use of two patient-identifiers through the implementation of an education program. This ten-week program involved education sessions that presented evidence-based material specifically focused on accurate and effective patient discharge, a pre/post-program survey measuring nurse attitude/perception and nurse comprehension/knowledge level, and a period of mentoring following the implementation period. The number of reported errors at discharge was evaluated before and after the program implementation to assess the effectiveness of the education. Nurse survey scores were evaluated both before and after education implementation to evaluate the effect that the education had on nurse attitude/perception and nurse comprehension/knowledge. There was no statistically significant increase in attitude/perception or comprehension/knowledge post-intervention; however, comprehension/knowledge was increased from a clinical standpoint. There was an 8.5% increase in comprehension/knowledge scores post-intervention and no identified patient-identification errors from January 2021 to the present. The intervention did not definitively prevent errors but was a factor that could have had an effect on these measurements. A patient identification-focused education program improves nurse comprehension/knowledge and accuracy of patient identification at discharge, leading to a reduced number of patient-ID errors and subsequent financial consequences

Inpatient mental health professionals\u27 perceptions of the discharge planning process

This study investigated perceptions of the discharge planning process by mental health professionals in a regional inpatient mental health service. The burden of mental illness in Australia is growing, with a corresponding increase in demand for services. Continuity of care and effective discharge planning for people with serious and enduring mental illness is considered a complex and multifaceted process. The aims of this study were to identify actual and ideal stakeholder involvement in the discharge planning process; timing and commencement of discharge planning; frequency of discharge activities; and barriers to efficient discharge planning in the inpatient mental health care setting. A review of relevant literature found overlap and a strong interrelationship in the concepts, definitions and key components of the discharge planning process and continuity of care. A questionnaire was developed for the study that was based on the themes and findings identified in the literature. Response scales were developed for most items on the questionnaire. Those questions without response scales sought participant comments related to particular sections within the questionnaire. Parametric testing of the data was undertaken using basic descriptive statistics, T-tests for matched pairs, reliability analysis of scales, and correlations. Comments provided by participants highlighted issues and gave additional meaning and depth to the quantitative data. The findings of the study identified a need for improved communication and care coordination between all stakeholders involved in the care and planning of discharge for people admitted to the acute inpatient mental health units. High bed demand and pressure to discharge patients prematurely was found to negatively impact on discharge planning. The study also identified a significant gap between actual and ideal involvement of stakeholders in the discharge planning process, and problems associated with timely and effective communication in everyday clinical practice. Barriers to efficient discharge planning were found to impact on the discharge process and limit involvement of patients, carers, hospital health care professionals and community care providers. The study concluded that inpatient mental health workers desire greater involvement in the planning of care, particularly as it relates to preparation for discharge. Perceptions of inequality in the level of involvement and care coordination within the multidisciplinary team lead to feelings of frustration and dissatisfaction, particularly among nurses. Stakeholders directly aligned with the inpatient setting tend to have more involvement in discharge planning than those stakeholders who are community based and who are external to the mental health service organisation. The study also concluded that when discharge planning begins earlier during hospitalisation, barriers related to time, ward factors and communication will have less of a negative affect on the outcome of discharge planning. Discharge planning becomes more effective when communication is more efficient, sufficient time is given to prepare, and relevant stakeholders (including hospital and community health care professionals, the patient and family) become involved earlier in the discharge planning process. Good discharge planning and the facilitation of continuity of care is regarded by mental health professionals as the responsibility of all stakeholders at all levels - this includes the organisation, individual mental health workers, the patient and their family and friends

Measuring Patient Satisfaction: A Study of Former Nursing Home Residents

It is be becoming more common for patients to be admitted short-term to nursing homes for rehabilitation and recovery, however, little attention is paid to their satisfaction with the services they receive. This study explores how patient satisfaction is related to discharge, using a quantitative survey research design. The survey was mailed to the universal sample of 60 patients discharged back to the community within a six-month time frame from a St. Paul nursing home. Findings indicate a correlation between how former patients rate their satisfaction with nursing home care and their preparedness at the time of their discharge. The significance of this study adds to the lack of research in nursing home patient satisfaction and provides indications for improvement in social work services in the nursing home setting. Implications for social work practice and policy are discussed

The Design, implementation and Evaluation of a Technology Solution to Improve Discharge Planning Communication in a Complex Patient Population

Unnecessary delays in discharge planning can extend the length of stay (LOS) and add non-reimbursable days for socially and medically complex patients thereby increasing the financial burden to healthcare organizations. The literature supports enhanced discharge communication strategies and the use of checklists to facilitate safe and timely discharges. Following root cause analyses of significant discharge delays, one hospital identified gaps in communication as key precursors associated with discharge planning breakdown when discharging patients to skilled nursing facilities. Review of these events demonstrated the need for concurrent communication strategies between multidisciplinary care team members in planning for complex discharges. Following a complete assessment of the current discharge planning process, a web-based interactive discharge checklist was designed, implemented and evaluated in the attempt to provide guided communications to the essential partners of the patient’s team in an effort to reduce LOS and readmissions. After a six-month rollout of the new technology and concomitant procedures, the analyses revealed improvement in both the patient’s perception of discharge planning and the ability to discharge patients by noon. Results for LOS and readmission demonstrated inconsistent improvement. The use of an electronic checklist as a communication tool did reduce variability in discharge procedures and provided for continuity in handoff communication between team members. Staff agreed it promoted continuity and improved efficiency

Effects of a Discharge Planning Intervention on Perceived Readiness for Discharge

This study was a quasi-experimental pilot study designed to determine the effectiveness of an interdisciplinary team to develop improved discharge teaching and process with inclusion of early provision of discharge goals, identification of barriers, and subsequent teaching and problem-solving of the barriers to impact patient perceived readiness for discharge. Discharge goals and barriers were identified early in the hospital stay for the intervention group and the control group received usual discharge planning. A questionnaire was given to the intervention group on admission to determine patient perceived goals and barriers. Based on the goals and barriers identified by the intervention group, the interdisciplinary team formulated an intensive discharge plan to meet patients’ goals and overcome barriers identified on admission. The investigator provided written goals at the bedside, planning brochure with video, and an anticipated discharge date was posted. A Perceived Readiness for Discharge Scale was administered prior to discharge to both groups, and two follow-up questionnaires post discharge were administered through follow-up phone calls. The phone calls and follow-up questionnaires were administered by an advanced practice nurse at 48-72 hours post discharge and at 10-14 days post discharge to assess any adverse events, patient satisfaction with the discharge process, and preparedness for discharge. This study contributed to knowledge present in the current literature which describes discharge planning and went further to investigate if an intensive discharge planning intervention through identification of goals and barriers early in the hospital stay improves perceived readiness for discharge. This study also looked at whether perceived readiness also influences patient satisfaction with the discharge process from hospital to home and if the concept of early identification of barriers and an intensive discharge process is associated with decreased adverse events and readmissions within 72 hours and 14 days post discharge

Post Discharge Follow-up Telephone Calls for Patients who Received Hospital Based Palliative Care Services to Improve Quality of Care and Outcomes: A Pilot Study

Background There is a rising number of patients with chronic health conditions concurrent with an increasing number of hospital readmissions within 30 days and emergency department visits. Predominantly based in acute care facilities, palliative care services have been effective in improving the quality of life in patients with chronic health conditions. However, the largest population that could benefit from palliative care services is community based in the home setting. Purpose The purpose of this project was the implement and evaluate follow-up telephone calls made in addition to visiting nursing (VNA) services to detect in early decline in patients who have received in-patient palliative care services compared to a 12-month retrospective analysis of a mirror population. Methods Five telephone calls were made over a 30-day time frame using the palliative performance scale as the method of measurement to augment VNA services with an additional layer of monitoring for early detection of decline. A 12-month retrospective analysis of a mirror population was performed for baseline comparison. ER visits, 30-day hospital readmissions, hospice admissions, and hospice lengths of stay were the methods of outcome. Results One participant was included in the implement telephone calls for inconclusive results. While, the retrospective data populations of 45 patients accounted for 141 hospitalizations, 71 30-day readmissions, 65 ER visits, 15 hospice admissions, and an average hospice length of stay of 58.3 days. Conclusions Patients who receive palliative care services in the hospital would benefit from the extension of in-person palliative care into the home setting for better symptom management and advanced care planning to improve quality of care and outcomes