Discharge planning in an acute hospital

To improve discharge planning on an acute medical ward, a nursing "team system" was initiated with clear delineation of responsibility for discharge planning. The head nurse supervised the nurses' actions and supported their communication with attending physicians. To assess the efficacy of this approach, chart reviews and interviews of 60 consecutive patients were performed before and after the implementation of the plan. A plan was labeled adequate if the following criteria were met: all treatable diagnoses were recognized; appropriate treatment regimens were instituted for each diagnosis; the patient's abilities were sufficient for him to function in the proposed environment; and plans were made for follow-up care. Patient knowledge was stated to be adequate if the patient was aware of his diagnosis, treatment regimen and plans for follow-up care. In addition, the patient was questioned concerning his satisfaction with the plans for further care. Seventy-five percent of the patients admitted to this ward required discharge planning. Of those requiring discharge planning, the plan was judged adequate in 55% prior to the program change and in 83% following that change. Eighty percent of the patients required some teaching during their hospital stay. Of these, by the time of discharge, knowledge was adequate in 53% prior to the program change and 51% subsequent to the change. Initially 68% of the patients were very satisfied with the discharge plans but this figure rose to 86% following the program change.