A discharge planning program in orthopaedics: experiences in implementation and evaluation

The acute care orthopaedic registered nurse plays a key role in assessing and communicating the continuing care needs of patient's and their families, coordinating community resources, and formulating a timely discharge plan to maximize rehabilitation and recovery. Developing and maintaining a staff nurse's discharge planning knowledge and skills can be a challenging endeavor. Discharge Planning Coordinators at a tertiary medical center developed and implemented a Discharge Planning Mentorship Program, an educational pilot program designed to enhance the knowledge and skill level of select nurses in the orthopaedic specialty practice, thus maximizing expert resources at the bedside. Program implementation and evaluation of role preparation, practice changes, and actualization challenges are discussed in this article. Overall, participants demonstrated increased skill in articulating and problem solving a patient's postdischarge needs, devised creative strategies to enhance communication between multiple levels of care, and developed a greater knowledge of community resources and reimbursement mechanisms for continuing care.