Improving Discharge by Creating a Discharge Nurse Position – the University of Texas M.D. Anderson Cancer Center, Houston, Texas
Provide a more effective discharge process for patients and a supportive work environment for nurses.
Staff created a special staff position—the unit-based discharge nurse—who is responsible for providing support to clinical nurses, patients and other team members to expedite patient discharge.
Nurses have more time for assigned patients, the discharge process has become more efficient and patients are better prepared for continuing care. Success in a pilot unit led to adoption in all the hospital's inpatient units within one year.
The University of Texas M.D. Anderson Cancer Center
1515 Holcombe Blvd. Box 82
Houston, TX 77030
P: (800) 392-1611
From the C-Suite:
“Slow discharge processes were frustrating our patients and our staff—and creating havoc with patient flow. By adding staff to manage and expedite the process in every unit, we dramatically improved efficiency and improved the quality of care we provide at discharge.”
Barbara L. Summers, Ph.D., R.N.
Vice President and Chief Nursing Officer, Division of Nursing
University of Texas M.D. Anderson Cancer Center
The University of Texas M.D. Anderson Cancer Center is a 507-bed, comprehensive cancer center.
Clinical areas affected:
- Entire hospital
- Clinical nurses
- Nurse leaders and managers
- Hospital management
A three-month pilot test was conducted in one unit in late 2005. This was later spread to all units and completed in late 2006. Hospital management budgeted for new positions in FY 2007.
Beverly A. Nelson M.S., R.N., C.N.A.A., B.C.
Director, Nursing Practice Programs
P: (713) 792-7112
Patients often have complex needs at discharge that require coordinating services with other agencies, obtaining medications and supplies, or arranging for professional/clinical services. Patients also need substantial instructions for continuing care. Attending to these needs has increased the time registered nurses must spend on discharge duties, making discharge much more time consuming.
To address these concerns, the unit began using an experienced nurse to support the clinical nurses by coordinating discharge activities, serving as a liaison to other team members and ensuring that all aspects of discharge are complete for patients and families. The regularly assigned nurse still works with the patient to plan for discharge and provide necessary support, but the discharge nurse assists in the process. They make contacts and phone calls to arrange for follow-up services, equipment and supplies, as well as reinforce patient instructions and preparations for discharge.
The new role was piloted with two or three experienced nurses trading off blocks of time in the discharge nurse role. Based on their success, other units also piloted the new position. It quickly became clear that this new role was applicable to all inpatient units and that these new positions would need to be budgeted. Hospital management agreed because the innovation was seen as part of a larger strategy for increasing patient flow, reducing length of stay, improving discharge times, and providing a better discharge experience for patients and families.
Advice and lessons learned:
- Make the discharge nurse's role consistent across all hospital units. At this site, nurse leaders created documents explaining the activities and expectations of individuals in the role. They also held regular meetings of discharge nurses and nurse leaders to discuss issues that were common across units, which provided a forum for problem solving and making consistent changes.
- Determine up front what metrics will be used to evaluate the role and its effectiveness. This site tracked data on discharge time, length of stay, barriers to timely discharge and patient satisfaction with the discharge process.
Data show that time for discharge has improved and there is better and more complete documentation related to discharge. Clinical nursing staff appreciates the support and patients generally report a positive experience with the discharge process.