Improving the discharge process by embedding a discharge facilitator in a resident team

Area of Science:

• Health Services Research
• Patient Safety
• Medical Education

Background:

• Hospital discharges are critical for patient safety, particularly in teaching hospitals.
• Resident physicians face competing demands during the discharge process.
• Improved discharge processes are needed to enhance patient outcomes.

Purpose of the Study:

• To assess if a nurse practitioner (NP) on a medical team improves discharge communication and patient follow-up.
• To evaluate the impact of an NP on hospital readmissions.
• To determine the effect on resident physician time and satisfaction.

Main Methods:

• A 5-month randomized controlled trial at an academic tertiary-care hospital.
• An NP was assigned to a resident team to manage discharge paperwork, appointments, and communication.
• Data collected on discharge summary completion, follow-up, patient satisfaction, and resident time.

Main Results:

• Intervention patients had significantly higher rates of timely discharge summaries and scheduled/attended follow-up appointments.
• Patient knowledge of who to contact post-discharge and satisfaction with the process improved.
• No significant difference in 30-day emergency department visits or readmissions was observed.

Conclusions:

• Integrating an NP into medical teams enhances discharge communication and patient follow-up processes.
• The intervention led to improved patient satisfaction and resident efficiency.
• The study found no effect on hospital reutilization for a general medicine population.