Nursing Recommendations to Improve Discharge and Care Transitions From the Bedside

Discharge planning is a complex and critical process that ensures continuity of care, reduces postdischarge complications, and prevents hospital readmissions. Bedside nurses, central to this process, offer valuable perspectives on barriers to safe discharge and care transitions. This study aimed to identify common challenges in discharge planning and highlight nurse-driven solutions to improve patient safety.

A cross-sectional survey was conducted with nurses from medical telemetry, cardiac observation, and short-stay observation units at a 520-bed tertiary academic teaching hospital from March 21 to April 30, 2022. Using the Agency for Healthcare Research and Quality's IDEAL Discharge Planning and Implementation Handbook as a framework, the survey assessed key challenges related to discharge and transitions of care. Participants rated their agreement with identified challenges, proposed solutions, and provided additional insights through an anonymous, 1-time survey.

Of 217 nurses contacted, 108 completed the survey (50% response rate). The majority identified significant barriers, including communication failures among care teams, care coordination gaps, medication reconciliation issues, and inadequate patient preparedness for discharge. Proposed solutions included implementing structured interprofessional communication protocols, enhancing discharge education strategies, and optimizing medication reconciliation processes.

This study underscores the systemic and operational barriers to safe discharge from the perspective of bedside nurses. Implementing targeted, evidence-based interventions informed by frontline staff insights can improve patient outcomes, reduce preventable harm, and enhance the discharge experience for patients and families.