Using a discharge nurse streamlines this administrative process and expedites the patient's return to home

NEW ORLEANS—Assigning the responsibility of following up on patients' discharge needs to one charge nurse can expedite the process and avoid unnecessary disruptions in patient care, and providing a ride home is also helpful, explained a discharge coordinator from a major comprehensive cancer center at the Oncology Nursing Society 37th Annual Congress.

Oncology nurses are always looking for ways to improve the care of hospitalized patients, such as streamlining administrative processes. Patients leaving the hospital are often delayed for various reasons such as supplies are not ready, their home caregivers need to observe teaching lessons, prescriptions are being filled, or the doctor wants to see the patient before discharge. The most frequent reason patient discharge is delayed, however, is waiting for a ride. Eileen Collins, RN, BSN, OCN®, Urology/GU Medicine at Memorial Sloan-Kettering Cancer Center in New York, New York, often saw that patients had to wait because their ride could not take time off from work or had other family members in their care.

Collins' goal was to find a way to expedite patient discharge that would keep the workflow of the hospital going and provide the best care in a timely manner. The idea of a charge nurse assuming the role of discharge coordinator addressed this need. This person would coordinate the discharge process with a multidisciplinary team of case managers, social workers, and clinicians to ensure all the patient's needs are addressed the afternoon before discharge.

The multidisciplinary team meets every morning to review the discharges for the day, and again in the afternoon, to check for any changes in patients' care plans. The discharge coordinator makes sure orders for supplies are placed and checked for accuracy, visiting nurse services are set up, and medications are ordered the day before discharge. The patient is told they will be going home the next day and a ride home is confirmed. This is when Collins found that many patients remained at the hospital until later in the day because they had to wait for a family member to be available.

MSKCC took the next step by contracting with a car service. Patients for whom the only holdup to discharge was a ride was offered the car service. However, they had to accept a strict discharge time of 11 am. This enabled the staff to facilitate the discharge, clean and prepare the bed for a new patient, and keep the workflow going while providing the best cancer care in a timely manner.

The discharge coordinator program at MSKCC significantly decreases discharge time, patients feel fully prepared to go home. In addition, having a contact person available for questions makes the discharge process easier and prevents disruptions in other patients' care. The car service provides some peace of mind for the patient and the family. It also enables the nursing staff to provide timely care right through discharge.

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