Document Type

DNP Project

Department

School of Nursing

Date of Degree

Spring 2022

Degree

Doctor of Nursing Practice (DNP)

Primary Advisor

Mary Jean Schumann, DNP, MBA, RN, CPNP-PC, FAAN; Laura Hendricks-Jackson, DNP, NEA-BC, RN-BC

Keywords

Re-Engineered Discharge (RED); Skilled Nursing Facility (SNF)

Abstract

Background: The growing population of people over the age of 65 years with surmounting medical complexities resulting in hospital re-admissions poses significant challenges for the healthcare system. Re-Engineered Discharge (RED) has demonstrated interventions inclusive of nursing driven discharge planning to successfully decrease hospital readmissions in Skilled Nursing Facilities (SNF).

Purpose: This aim of this quality improvement initiative was to improve discharge efficiency by implementing a modified version of RED to evaluate the effect of centralizing nursing in education and discharge processes and influence on all-cause 30-day readmission rates.

Methods: A pre and post intervention design was utilized for patient chart review (N=93, pre n=47, post n=46) and nursing surveys. The Self-Directed Learning Readiness Scale-Adult Learning Preference Assessment (SDLRS-A) and discharge surveys evaluated nurses’ (N=30) attitudes, beliefs of learning, and the discharge processes. RED education sessions were designed to improve clinical care, nursing documentation, and patient education.

Results: SDLRS-A scores indicated 87.3% nurses had high level of readiness to learn (n=24, M=235.17, SD=25.38). Mann-Whitney test showed statistical significance pre/post nurses survey median scores. All-cause 30-day readmissions were insignificant (p = .098). Chi square was significant (p = < .001) for follow-up appointments, post discharge calls, and nursing presence at multidisciplinary meetings. HCAPHS scores indicated substantial increase in nursing scores.

Conclusion: RED demonstrated centralizing nursing in patient education and discharge processes had a substantial impact on SNF patient outcomes and increased HCAPHS scores.

Recommendation: SNFs can utilize nurses to implement and sustain RED to influence readmissions and improve populations’ health outcomes for people over the age of 65 years.

Open Access

1

Available for download on Tuesday, April 25, 2023

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