Improving transitional care in rural health using a standardized discharge time-out process
Review TypeFaculty Approved: Degree-based Submission
Repository Posting Date2020-06-24T20:57:24Z
Author DetailsMary Vanderhoef, DNP, APRN - faculty chairperson for this project. Jacksonville University and Lori Koethe, RN,MS, DNP (c) - primary author. firstname.lastname@example.org
Lead Author Sigma AffliationNon-member
TypeDNP Capstone Project
Level of EvidenceQuality Improvement
Research ApproachTranslational Research/Evidence-based Practice
KeywordsRural; Patient Discharge; Time-Out; Checklist; Transitional Care; Patient Satisfaction; Medical Errors; COVID-19; Meleis’ Theory of Transitions
Problem: The process for transitioning patients from hospital to home is complex and fraught with opportunity for error. Increasingly, hospitals are tasked with regulatory, safety, and public expectation burdens to ensure that safe, effective transitions from hospital are well-planned, well-communicated and collaborative.
Purpose: Transitional care processes are well documented in large, academic medical centers. Little evidence exists within the rural healthcare community. We sought to determine if the implementation of a discharge time-out could improve patient satisfaction and identify and correct errors prior to discharge.
Methods: Using Meleis’ Theory of Transitions, a standardized discharge time-out process was implemented and delivered collaboratively by RNs and pharmacists. Teach-back methodology was used to validate patient or caregiver knowledge.
Interventions: Modeled after a surgical time-out, a time-out was performed within 30 minutes of discharge instructions to validate discharge plans.
Results: Implementation of the planned process was affected mid-project by implementation of COVID-19 visitation and care delivery restrictions. Patient satisfaction was positively affected by the process. Near miss medication errors and need for medication education were identified and corrected prior to discharge.
Conclusion: Little is known about the efficacy of TCM in rural health care settings, but the importance of safe, effective transitions within this vulnerable population is critical to achieve the Triple Aim. Statistically significant improvements in patient satisfaction related to discharge readiness, error identification and educational gaps provides additive information that supports the need for standardized processes to transition patient’s safety from hospital to home. As seen in this project, nurses are critical to the success of any suggested process as the front-line caregivers in or out of a pandemic.
Degree GrantorJacksonville University
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