School of Nursing
Date of Degree
Doctor of Nursing Practice (DNP)
Karen S. Kesten, DNP, APRN, CCNS, CNE, FAAN; Margaret Venzke DNP, RN, FNP-BC
IDEAL Discharge Protocol; Quality Improvement Initiative; Older Adults; Discharge Process
Background: Readmissions are costly and adversely affect patient outcomes. Readmissions significantly impact older adults’ ability to manage post-discharge. Older adults are more likely to have challenges with understanding newly prescribed medications after discharge and therefore are less compliant with medications. Older adults are also less likely to follow-up with their primary care physician after discharge. Engaging patients and families in a collaborative discharge process is a key foundational element needed to improve patient outcomes and reduce avoidable readmission rates.
Purpose: This quality improvement initiative engaged patients and families in an evidence-based discharge protocol to reduce avoidable readmission over three months.
Methods: The Define, Measure, Analyze, Design, and Verify (DMADV) improvement process was used to implement the initiative. The IDEAL Discharge Protocol was piloted on one medical-surgical unit targeting adults 65 years or older with no cognitive deficits and discharged home. The IDEAL Discharge Protocol focused on implementing a structured process to include patients and their families in a collaborative care process focused on discussion, education, and post-discharge follow-up.
Results: Forty-four participants engaged in the study. A 4 percent decrease in the pilot unit readmission rate was observed. Before implementation, the readmission rate was 17 percent. After implementation, the readmission rate was 13 percent. Post-discharge follow-up resulted in the completion of 52.2 percent follow-up calls and 45.5 percent follow-up appointments scheduled. Of the 44 participants engaged in the intervention, two were readmitted, resulting in a 4.5 readmission rate for the study participants. Medication compliance was assessed and found to be 93.3 percent, and 100 percent of participants received education while engaged in the study.
Conclusion: The IDEAL intervention aided in improving the discharge process to better equip patients with the tools to successfully transition home after discharge and showed a trend toward reducing the pilot unit’s readmission rate.
©2021 Ava D. Williams. All rights reserved.
Williams, MSN, CRNP FNP-BC, A. D. (2021). A Quality Improvement Initiative to Engage Older Adults in the Discharge Process Using the IDEAL Discharge Protocol. , (). Retrieved from https://hsrc.himmelfarb.gwu.edu/son_dnp/91
Available for download on Monday, January 15, 2024