Discharge Readiness Of Patients Research Articles

Status Quo and Influencing Factors of Discharge Readiness of Patients with Bilateral Ureteral Stoma After Radical Cystectomy.

Bladder cancer is a common malignancy of the urinary system, which occurs mostly in elderly men, and the incidence is increasing year by year. To analyze the status quo and related factors of discharge readiness of patients with bilateral ureteral stoma after radical cystectomy, a retrospective, noncomparative was performed. 544 patients with bilateral ureteral stoma after radical cystectomy in our hospital from December 2018 to December 2020 were selected. The self-designed questionnaire, discharge readiness scale (RHDS) and discharge guidance quality scale (QDTS) were used to investigate the general data, and multiple linear regression was used to analyze the related influencing factors. The total score of RHDS was (72.57 ± 18.56) and the total score of QDTS was (105.63 ± 24.18); the total score of RHDS was positively correlated with the total score of QDTS (r = 0.882, p = 0.000); the results of multiple linear regression showed that age, discharge direction and care mode were the main factors influencing the discharge readiness of patients (p < 0.05). In conclusions, the discharge readiness of patients with bilateral ureteral stoma after radical cystectomy is in the medium level, and there is a large space for improvement. Nurses should strengthen the guidance and nursing of patients’ discharge preparation to reduce the incidence of postoperative complications and readmission rate.

Perceived Learning Needs and Readiness for Hospital Discharge of Patients with Acute Myocardial Infarction in a Selected Hospital, Kottayam

Perceived Learning Needs and Readiness for Hospital Discharge of Patients with Acute Myocardial Infarction in a Selected Hospital, Kottayam

Factors Influencing Readiness for Hospital Discharge among Patients Undergoing Breast Cancer Surgery

Background: Breast cancer has become an important disease burden harmful to women’s health. The treatment of breast cancer is mainly surgical treatment. In the context of enhanced recovery after surgery, the average length of hospital stay has been reduced, so there is increasing concern about postoperative patient discharge readiness. Objective: To identify factors influencing readiness for hospital discharge among patients having undergone breast cancer surgery and to explore the relationship between discharge readiness and the quality of discharge teaching. Methods: A total of 99 patients after breast cancer surgery at a regional tertiary medical tumor center in Guangzhou between June 2021 and December 2021 were collected using the convenience sampling method. A general data questionnaire, readiness for hospital discharge scale, and quality of discharge teaching scale were used to conduct a questionnaire survey on the subjects. Results: 83.8% of the patients feel ready for discharge, and the score of discharge readiness was 155.98 ± 28.87. The patients’ content received and the skills in teaching delivery were the influencing factors of discharge readiness. Discharged with a drainage tube was an independent factor of discharge readiness. Conclusions: Readiness for hospital discharge among patients undergoing breast cancer surgery was above medium level, and perfect intervention measures should be formulated for the influencing factors of discharge readiness. Especially, specific executable safeguard measures should be formulated for patients who are discharged early after surgery to promote the safety of home care.

The Effectiveness of a Multidisciplinary Electronic Discharge Readiness Tool: Prospective, Single-Center, Pre-Post Study.

BackgroundIn the face of hospital capacity strain, hospitals have developed multifaceted plans to try to improve patient flow. Many of these initiatives have focused on the timing of discharges and on lowering lengths of stay, and they have met with variable success. We deployed a novel tool in the electronic health record to enhance discharge communication.ObjectiveThe aim of this study is to evaluate the effectiveness of a discharge communication tool.MethodsThis was a prospective, single-center, pre-post study. Hospitalist physicians and advanced practice providers (APPs) used the Discharge Today Tool to update patient discharge readiness every morning and at any time the patient status changed throughout the day. Primary outcomes were tool use, time of day the clinician entered the discharge order, time of day the patient left the hospital, and hospital length of stay. We used linear mixed modeling and generalized linear mixed modeling, with team and discharging provider included in all the models to account for patients cared for by the same team and the same provider.ResultsDuring the pilot implementation period from March 5, 2019, to July 31, 2019, a total of 4707 patients were discharged (compared with 4558 patients discharged during the preimplementation period). A total of 352 clinical staff had used the tool, and 84.85% (3994/4707) of the patients during the pilot period had a discharge status assigned at least once. In a survey, most respondents reported that the tool was helpful (32/34, 94% of clinical staff) and either saved time or did not add additional time to their workflow (21/24, 88% of providers, and 34/34, 100% of clinical staff). Although improvements were not observed in either unadjusted or adjusted analyses, after including starting morning census per team as an effect modifier, there was a reduction in the time of day the discharge order was entered into the electronic health record by the discharging physician and in the time of day the patient left the hospital (decrease of 2.9 minutes per additional patient, P=.07, and 3 minutes per additional patient, P=.07, respectively). As an effect modifier, for teams that included an APP, there was a significant reduction in the time of day the patient left the hospital beyond the reduction seen for teams without an APP (decrease of 19.1 minutes per patient, P=.04). Finally, in the adjusted analysis, hospital length of stay decreased by an average of 3.7% (P=.06).ConclusionsThe Discharge Today tool allows for real time documentation and sharing of discharge status. Our results suggest an overall positive response by care team members and that the tool may be useful for improving discharge time and length of stay if a team is staffed with an APP or in higher-census situations.

Development and Implementation of a Multidisciplinary Electronic Discharge Readiness Tool: User-Centered Design Approach.

BackgroundTypical solutions for improving discharge planning often rely on one-way communication mechanisms, static data entry into the electronic health record (EHR), or in-person meetings. Lack of timely and effective communication can adversely affect patients and their care teams.ObjectiveApplying robust user-centered design strategies, we aimed to design an innovative EHR-based discharge readiness communication tool (the Discharge Today tool) to enable care teams to communicate any barriers to discharge, the status of patient discharge readiness, and patient discharge needs in real time across hospital settings.MethodsWe employed multiple user-centered design strategies, including exploration of the current state for documenting discharge readiness and directing discharge planning, iterative low-fidelity prototypes, multidisciplinary stakeholder meetings, a brainwriting premortem exercise, and preproduction user testing. We iteratively collected feedback from users via meetings and surveys.ResultsWe conducted 28 meetings with 20 different stakeholder groups. From these stakeholder meetings, we developed 14 low-fidelity prototypes prior to deploying the Discharge Today tool for our pilot study. During the pilot study, stakeholders requested 46 modifications, of which 25 (54%) were successfully executed. We found that most providers who responded to the survey reported that the tool either saved time or did not change the amount of time required to complete their discharge workflow (21/24, 88%). Responses to open-ended questions offered both positive feedback and opportunities for improvement in the domains of efficiency, integration into workflow, avoidance of redundancies, expedited communication, and patient-centeredness.ConclusionsSurvey data suggest that this electronic discharge readiness tool has been successfully adopted by providers and clinical staff. Frequent stakeholder engagement and iterative user-centered design were critical to the successful implementation of this tool.

Readiness for hospital discharge and influencing factors: a cross-sectional study on patients discharged with tubes from the department of hepatobiliary surgery

BackgroundTo investigate the readiness for hospital discharge of patients discharged with tubes from the department of hepatobiliary surgery and to explore the influencing factors.MethodsA cross-sectional survey was conducted for the 161 patients with tubes who were discharged from the department of hepatobiliary surgery of Shaoxing Second Hospital by using the modified Chinese version of Readiness for Hospital Discharge Scale (RHDS) and Quality of Discharge Teaching Scale (QDTS). General data of the patients, such as gender, age, BMI (body mass index), and educational level, were collected.ResultsAccording to the statistical results, the total score of the RHDS was 142.40 ± 23.98, and that of the QDTS was 148.14 ± 17.74. Multiple linear step-wise regression analysis revealed that the total score of the QDTS, residence and educational level were the independent influencing factors of the readiness for hospital discharge (p < 0.05).ConclusionThe level of the readiness for hospital discharge of the 161 discharged patients with tubes from the department of hepatobiliary surgery was in the middle and lower level. For the patients who are far away from the hospital and have a low education level, we should pay more attention to health education and discharge teaching, so as to improve the readiness for hospital discharge of relatively vulnerable patients, reduce the incidence of adverse events after discharge with tubes, and ensure the health and safety of patients.

Analysis of the Current Status and Influencing Factors of the Readiness for Discharge of Patients after Prostate Cancer Surgery Based on the Concept of Enhanced Recovery after Surgery (ERAS)

Objective To investigate the level of readiness for discharge of patients after prostate cancer surgery based on the concept of Enhanced Recovery After Surgery (ERAS), and to explore its influencing factors, so as to provide references for improving the readiness for discharge of patients after prostate cancer surgery. Methods The general information questionnaire, the discharge preparation scale, and the discharge guidance quality scale were used to investigate 119 patients discharged from the urological surgery department of a tertiary A-level hospital in Guangzhou after radical prostatectomy. Results The total score of discharge readiness of patients after radical prostatectomy was 147.74 ± 35.71 points, which was at a lower middle level and the total score of discharge guidance quality was 180.68 ± 38.91 points, which was at a medium level. Multiple linear regression analysis showed that education level, family monthly income, Gleason score, whether to perform lymphatic dissection, whether to discharge with a urinary catheter, and the quality of discharge guidance were the main factors influencing the readiness for discharge of patients after prostate cancer surgery. Conclusion In clinical nursing work, it is necessary to implement individualized health education according to the characteristics and needs of different patients to improve the level of preparation for discharge of patients after prostate cancer surgery.

Dahili Kliniklerde Yatan Hastaların Hemşirelik Bakım Memnuniyeti ve Taburculuğa Hazır Olma Durumları: Tanımlayıcı Kesitsel Araştırma Örneği

Objective: This descriptive and cross-sectional study was conducted to evaluate the nursing care satisfaction and readiness for hospital discharge of patients hospitalized in internal medicine clinics. Material and Methods: The universe of this study consisted of patients treated in the internal clinics of Atatürk University hospital between May and September 2019. The sample of the study, on the other hand, consisted of 372 patients aged 18 and over who did not have hearing, vision and mental problems, voluntarily accepted to participate in the study, had cognitive competence to answer the questions. The data were collected by using 'personal information form', 'Newcastle Nursing Care Satisfaction Scale', and 'Readiness for Hospital Discharge Scale'. Results: It was found that average age of the patients in the study was 58.7±17.5 years; 50.8% were male, 29.8% were illiterate, 90.6% were married, 78.5% had a moderate level of income, 59.4% were hospitalized from the outpatient clinics and 70.7% were very satisfied with nursing care. Average nursing care satisfaction of the patients was found to be 88.23±12.5. Readiness for hospital discharge total score of the patients was 6±1.99 and the highest score was taken from expected support sub-dimension (9.05±1.83), while the lowest score was taken from knowledge (4.18±4.15) sub-dimension. A statistically significant inverse relationship was found between the age and number of hospitalizations of the patients and the total score of the Readiness for Hospital Discharge Scale, personal care and coping skills sub-dimension scores (p<0.05). Conclusion: It was found that the patients had high nursing care satisfaction levels and that they were not sufficiently ready for discharge.

Impact of readiness for discharge from the hospital on the implementation of the therapeutic plan

Introduction. Adherence to therapeutic recommendations regarding pharmacotherapy and lifestyle modification reduces the risk of complications in patients after myocardial infarction. The assessment of readiness for discharge allows to get knowledge about patient’s preparation for functioning at home. The aim of the study is to assess the relationship between the readiness for discharge of patients after myocardial infarction and adherence to pharmacotherapy based of the analysis of prescription filling. Material and methods. The study is a single-center, prospective, observational cohort clinical trial with a one-year follow-up period. The study population include 225 patients (26.7% women and 73.3% men) aged 30–91years (62.9 ± 11.9). The RHD-MIS (Readiness for Hospital Discharge after Myocardial Infarction Scale) was used to assess the readiness for discharge. Adherence to medication has been studied in relation to ACE inhibitors, P2Y12 receptor inhibitors and statins. Results. Patients with a high overall RHD MIS score compared to those with an average result were more likely to have any breaks in therapy, p = 0.01 (breaks < 30 days, p = 0.03 and breaks ≥ 30 days, p = 0.005) for either drug. Patients declaring that their disease is not serious have significantly lower adherence to P2Y12 receptor inhibitor (28 ± 27% vs 72 ± 38%, p = 0.047) and statins (36 ± 41% vs 76 ± 33% p = 0.024) in the 1st quarter after discharge and to statins (23 ± 18% vs 65 ± 32% p = 0.014) during whole one-year follow-up. Conclusion. The readiness for discharge from the hospital assessed with the RHD-MIS does not clearly affect the implementation of the therapeutic plan in the long-term follow-up in patients after myocardial infarction. Data suggesting a negative impact of some aspects of readiness for discharge on adherence to treatment require further, in-depth research.

Ready to Go Home? Assessment of Shared Mental Models of the Patient and Discharging Team Regarding Readiness for Hospital Discharge.

A critical task of the inpatient interprofessional team is readying patients for discharge. Assessment of shared mental model (SMM) convergence can determine how much team members agree about patient discharge readiness and how their mental models align with the patient's self-assessment. Determine the convergence of interprofessional team SMMs of hospital discharge readiness and identify factors associated with these assessments. We surveyed interprofessional discharging teams and each team's patient at time of hospital discharge using validated tools to capture their SMMs. Discharge events (N = 64) from a single hospital consisting of the patient and their team (nurse, coordinator, physician). Clinician and patient versions of the validated Readiness for Hospital Discharge Scales/Short Form (RHDS/SF). We measured team convergence by comparing the individual clinicians' scores on the RHDS/SF, and we measured team-patient convergence as the absolute difference between the Patient-RHDS/SF score and the team average score on the Clinician-RHDS/SF. Discharging teams assessed patients as having high readiness for hospital discharge (mean score, 8.5 out of 10; SD, 0.91). The majority of teams had convergent SMMs with high to very high interrater agreement on discharge readiness (mean r*wg(J), 0.90; SD, 0.10). However, team-patient SMM convergence was low: Teams overestimated the patient's self-assessment of readiness for discharge in 48.4% of events. We found that teams reporting higher-quality teamwork (P = .004) and bachelor's level-trained nurses (P < .001) had more convergent SMMs with the patient. Measuring discharge teams' SMM of patient discharge readiness may represent an innovative assessment tool and potential lever to improve the quality of care transitions.

The factors of patient-reported readiness for hospital discharge in patients with depression: A cross-sectional study.

WHAT IS KNOWN ON THE SUBJECT?: The attributes of readiness for hospital discharge (RHD) have been identified to be physical stability, adequate support, psychological ability, and adequate information and knowledge. Patient-reported RHD has been regarded as an outcome indicator, and poor RHD leads to unplanned readmission, emergency department visits and even death. Knowledge regarding patient-reported RHD and its factors among patients with depression is limited. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: RHD among patients with depression is at a moderate level. More than a quarter of people with depression had low RHD. The knowledge dimension of the RHDS among patients with depression should be further strengthened. The length of stay, content received and delivery dimensions of the QDTS were significantly associated with RHD. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This study encourages nurses to assess patient-reported RHD at discharge in mental health settings. Nurses should pay more attention to patients with hospital stays longer than 20days. Nurses could improve RHD by enhancing the quality of discharge teaching, particularly the content received and the skills nurses used to deliver such content. Nurses' managers could develop programmes to improve teaching skills via Internet technology, such as simulated patients and online interprofessional discharge planning. ABSTRACT: Introduction Low readiness for hospital discharge (RHD) can be followed by negative healthcare outcomes. However, no studies have investigated RHD among patients with depression. Aim This study aimed to examine patient-reported RHD and its factors among patients with depression. Method In total, 367 inpatients with depression were recruited and completed the Readiness for Hospital Discharge Scale (RHDS) and Quality of Discharge Teaching Scale (QDTS). A binary logistic regression analysis was performed to explore the factors of RHD among patients with depression. Results The total RHDS score was 7.70±1.52. Approximately 28.9% of the participants had low RHD (RHDS score<7). The results revealed that RHD was significantly associated with the length of stay, content received and delivery. Discussion RHD among patients with depression is at a moderate level. More than a quarter of people with depression had low RHD. To improve RHD, enhancing the quality of discharge teaching is imperative for patients with depression. Implications for Practice Nurses should pay more attention to patients with a hospital stay longer than 20days. Nurses could improve RHD by enhancing the quality of discharge teaching, particularly the content received and the skills nurses used to deliver such content.

The use of the reds noninvasive lung fluid monitoring system to assess readiness for discharge in patients hospitalized with acute heart failure: A pilot study

BackgroundInadequate decongestion is common in hospitalized heart failure (HF) patients and may contribute to readmissions. Our purpose was to use remote dielectric sensing (ReDS) technology to measure lung congestion at discharge in patients admitted with acute HF and to see if a device-targeted intervention could reduce HF readmission rates. MethodsWe conducted a prospective pilot study of patients admitted with acute decompensated HF randomized to receive standard therapy or ReDS-guided therapy to determine the timing of hospital discharge based on the amount of lung congestion present after diuresis. ReDS measurement was performed for all patients once they were deemed ready for discharge. Patients in the treatment arm with residual lung congestion defined by ReDS ≥39% had HF consultation and further diuresis. ResultsOf 108 HF patients (50% male, age 73.6 ± 12.6 years, BMI 29.3 ± 4.3 kg/m2, EF 38.5 ± 15.1%, BNP 1138 ± 987 pg/mL), 32% demonstrated residual lung congestion at the time of proposed hospital discharge. ReDS guided therapy triggered additional diuresis in 30% (18/60) of the patients in the treatment arm (average weight loss 5.6 pounds, p = 0.02). 30-day HF readmission rates were similar in the treatment and the control arms (1.7% vs 4.2%; p = 0.44). Patients discharged as planned with residual lung congestion with ReDS ≥39% had higher 30-day readmission rate compared to patients who were adequately decongested at discharge with ReDS <39% (11.8% vs. 1.4%, p = 0.03). ConclusionIn our single-center cohort, ReDS testing demonstrated that 32% of HF patients deemed ready for discharge have clinically significant residual lung congestion which was associated with a higher risk of readmission. ReDS-guided management was associated with significant decongestion but not a reduction in HF readmissions in this sample.

The effect of caregiver's and nurse's perception of a patient's discharge readiness on postdischarge medical resource consumption.

The purpose of this study was to validate patient's primary caregiver and their nurse's perception of patient discharge readiness assessment and their association with postdischarge medical consumption. The study employed a descriptive research, prospective longitudinal study design. The study was performed in a ward of a medical centre in Taipei, Taiwan, from June 2017-May 2018. Obtained data were analysed using an independent t test, one-way ANOVA and logistic regression approach. The number of comorbidities and the number of days of hospital stay were positively associated with post discharge emergency room visits. Caregiver readiness for hospital discharge had significant negative correlation with patient's 30-day readmission. Both caregiver and nurse readiness for the hospital discharge scale score were not factors associated with the patients' 30-day emergency room visit. Based on the research findings, to assess the discharge readiness as perceived by caregivers at patients' discharge is recommended. Caregiver and nurse scores on readiness for hospital discharge showed a significant positive correlation. The higher the score of a caregiver's readiness for a patient's hospital discharge, the lower the 30-day readmission rate. Family-centred care enables patients to safely pass though the transition phase from hospital to community and reduces the postrelease consumption of medical resources. The discharge readiness perceived by caregivers should be included in any decision-making.

Measuring Sleep Orthopnea using the Angle of Bed in Heart Failure to Assess Readiness for Discharge

Background Few reliable, non-invasive clinical markers have been identified for evaluating readiness for discharge in patients with heart failure. Worsening sleep orthopnea, including the use of additional pillows, has long been considered a sign of worsening heart failure symptoms, however in the hospital the adjusted angle of the bed could be another way to assess sleep orthopnea. This study examined variation in the angle of the bed, whether the angle of bed the night prior to discharge could be useful as a non-invasive clinical indicator and whether there is a relationship between the angle of bed while patients are sleeping the night prior to discharge and 30-day readmission. Objectives It was hypothesized that the angle of the head of bed the night prior to discharge from the index admission would be higher in patients who are readmitted within 30 days of discharge. In addition, it was hypothesized that the correlation between angle of bed and amount of diuresis would allow for use of angle of bed as a clinical indicator. Methods In this prospective observational study, nurses measured the angle at which patients self-adjusted the bed for nighttime sleeping. Patients from a progressive cardiac care unit were included if the primary admitting diagnosis was volume overload related to heart failure. Results Patients (n = 145) were 46.2% female, 46.2% African American with a mean age of 63.4 ± 14.7 years. Mean length of stay was 12.5 ± 10.5 days, and 22.8% were readmitted within 30 days. The average angle of bed prior to discharge was 29.1 ± 18.7 degrees and only 13% were able to lay flat while sleeping on the night prior to discharge. There was a significant difference between the highest and lowest angle of HOB (p Conclusions We did not demonstrate the utility of angle of bed the night prior to discharge as a marker of readiness for discharge in patients with heart failure. However, this innovative, nurse-led project did demonstrate that angle of bed is non-invasive and easy to capture. Further studies should consider the role of angle of bed as an indication of orthopnea and in evaluating readiness for discharge during a heart failure admission.

Analysis of the Status Quo and Influencing Factors of Readiness for Hospital Discharge of Patients Undergoing Hysteromyomectomy

Objective: To evaluate the status quo and influencing factors of readiness for hospital discharge of patients undergoing hysteromyomectomy. Methods: A total of 240 patients with uterine fibroid undergoing hysteromyomectomy from 2 hospitals in Jingzhou were investigated using a self-designed general information questionnaire, the Readiness for Hospital Discharge Scale and the Quality of Discharge Teaching Scale. Results: The total score of readiness for hospital discharge was (91.36 ± 18.46), the multiple linear regression analysis showed that the quality of discharge guidance, the scope of myomectomy, pain degree of incision and the average monthly income per family were the main influencing factors of readiness for hospital discharge. Conclusion: The readiness for hospital discharge was at a medium level in patients with uterine fibroid undergoing hysteromyomectomy, medical personnel should give specific discharge guidance according to the specific conditions of patients to ensure the safety of patients after discharge.

546: Early postpartum readmissions or emergency department visits: Identifying risk factors

Postpartum readmissions and emergency department visits have emerged as a focus of maternal care quality improvement. Our objective was to investigate factors associated with early readmissions and emergency department visits (RED) after delivery, as these might reflect maternal discharge readiness. We analyzed linked vital statistics and hospital discharge records of California women who gave birth during 2007-2012. We defined RED as a hospital readmission or emergency department visit within 30 days after birth hospitalization. We used multivariable logistic regression to compare women with early RED (0-3 days) or later RED (4-30 days) to women with no RED within 30 days (reference), based on the following factors: medical or obstetric comorbidities or severe maternal morbidity (SMM) at delivery, birth hospitalization length of stay (LOS), cesarean delivery (CD), and birth hospital delivery volume and teaching status. Among 2,843,855 women, 38,154 (1.3%) had early and 100,738 (3.5%) had later RED. After adjustments, we found increased odds of early RED associated with medical (aOR=1.7) and obstetric (aOR=1.7) comorbidities, SMM at delivery (aOR=2.1), extended LOS (aOR=1.4) and CD (aOR=1.6) (Table). Adjusted odds for later RED were similar. High-volume and teaching hospitals cared for patients with higher comorbidity scores (p< 0.01). Compared to delivery at high-volume hospitals, delivery at hospitals with < 500 deliveries/year was associated with increased odds of early (aOR=1.3) as well as later RED (aOR=1.4). Delivery at a teaching hospital was protective of both early and later RED. Women with higher co-morbidity scores, SMM at delivery, longer birth hospital LOS and CD had increased odds for early as well as later RED. Prior to discharge of these patients, there might be opportunities for improved surveillance. Even though higher-volume and teaching hospitals cared for higher-risk women, their early as well as later RED rates were lower. Evaluation of systems of care at larger and teaching hospitals may reveal practices to improve patient discharge readiness.

Individual Nurse Productivity in Preparing Patients for Discharge Is Associated With Patient Likelihood of 30-Day Return to Hospital.

Applied to value-based health care, the economic term "individual productivity" refers to the quality of an outcome attributable through a care process to an individual clinician. This study aimed to (1) estimate and describe the discharge preparation productivities of individual acute care nurses and (2) examine the association between the discharge preparation productivity of the discharging nurse and the patient's likelihood of a 30-day return to hospital [readmission and emergency department (ED) visits]. Secondary analysis of patient-nurse data from a cluster-randomized multisite study of patient discharge readiness and readmission. Patients reported discharge readiness scores; postdischarge outcomes and other variables were extracted from electronic health records. Using the structure-process-outcomes model, we viewed patient readiness for hospital discharge as a proximal outcome of the discharge preparation process and used it to measure nurse productivity in discharge preparation. We viewed hospital return as a distal outcome sensitive to discharge preparation care. Multilevel regression analyses used a split-sample approach and adjusted for patient characteristics. A total 522 nurses and 29,986 adult (18+ y) patients discharged to home from 31 geographically diverse medical-surgical units between June 15, 2015 and November 30, 2016. Patient discharge readiness was measured using the 8-item short form of Readiness for Hospital Discharge Scale (RHDS). A 30-day hospital return was a categorical variable for an inpatient readmission or an ED visit, versus no hospital return. Variability in individual nurse productivity explained 9.07% of variance in patient discharge readiness scores. Nurse productivity was negatively associated with the likelihood of a readmission (-0.48 absolute percentage points, P<0.001) and an ED visit (-0.29 absolute percentage points, P=0.042). Variability in individual clinician productivity can have implications for acute care quality patient outcomes.

Pathway to Patient Discharge Through Multidisciplinary Discharge Rounds

Multidisciplinary discharge rounds (MDDRs) provide the opportunity for a variety of disciplines to gather and discuss patient discharge readiness. Discharge is an important clinical milestone in patient care, and the length of stay (LOS) is critical to maintaining good financial stewardship. Fiscal year data for 2017–2018 showed an LOS well above the national average for other large, metropolitan academic centers. Clinically, nine missed care opportunities occurred in the 3 months before the MDDRs pilot. It was hypothesized that implementation of MDDRs would decrease LOSs and improve clinical and financial outcomes. MDDRs have been implemented with the intent to better coordinate care prior to discharge, particularly for patients with complex needs. To secure bedside nursing support for MDDRs, a workshop was held that included six nurse champions for the project. The workshop was based on the Six Sigma Work-out framework, starting with brainstorming and ending with nursing leadership approval of the new process for implementing daily MDDR rounds. A 12-week pilot was conducted, and MDDRs were held at 9:00 a.m. each day. The nurses, case managers, social workers, and available physicians attended, including the medical director of the newborn nursery. The clinical nurse specialist, M/B manager, and the M/B educator facilitated MDDRs. LOSs were reduced significantly for both cesarean and vaginal births by 18 hours and 9 hours, respectively. The institution with over 5,000 births per year has a 40% cesarean birth rate. This translates to yearly savings for cesarean births of 36,000 hours and 27,000 hours saved on LOSs after vaginal births. The opportunity days equals 2,625. Clinical outcomes were also improved, as there were no reports of missed care in the 3 months of the pilot (evidenced by no entries in the event management system). MDDRs can be successfully implemented in any hospital service. Including nursing staff in the development and planning of MDDRs helps ensure staff buy-in. This buy-in is key to successful implementation of MDDRs.

Discharge readiness of patients with acute cholecystitis undergoing laparoscopic cholecystectomy and its influencing factors

Objective This study was aimed to describe the status of discharge readiness of patients with acute cholecystitis undergoing laparoscopic cholecystectomy (LC) and explore its influencing factors. Methods Convenient sampling method was used to select 396 patients with acute cholecystitis undergoing LC at the Department of Biliary Surgery at West China Hospital from July 2016 to March 2018. Clinical Data Questionnaires, Discharge Readiness Scale, and Discharge Guidance Quality Scale were adopted to assess patients' discharge readiness and discharge guidance quality, and the correlation between the two variables was analyzed. Multi-linear regression analysis was used to analyze the influencing factors of discharge readiness. Results In this study, the total score of discharge readiness in patients with acute cholecystitis undergoing LC was (176.95±29.37) , and the total score of discharge guidance quality was (149.31±30.77) , which were both at upper-middle levels. Multi-linear regression analysis showed that the education level, family average monthly income, numbers of long-term medications required, place of residence and discharge guidance quality were influencing factors of discharge readiness of patients with acute cholecystitis undergoing LC (β'=0.491, 0.278, -0.321, 0.356, 0.619; P<0.05) . Pearson correlation analysis showed that discharge guidance quality was positively correlated with discharge readiness in patients with acute cholecystitis undergoing LC (r=0.602, P<0.01) . Conclusions The discharge readiness was at an upper-middle level in patients with acute cholecystitis undergoing LC. Medical care staff should formulate intervention strategies based on the influencing factors and increase the discharge guidance quality, in order to improve discharge readiness and accelerate the recovery process. Key words: Cholecystitis, acute; Cholecystectomy, laparoscopic; Discharge readiness; Discharge guidance; Influencing factors

The status of the discharge readiness in patients with intracranial aneurysm undergoing interventional therapy and its influencing factors

Objective To describe the status of discharge readiness of patients with intracranial aneurysm undergoing interventional therapy and explore its influencing factors. Methods Easy sampling method was used to select 136 patients with intracranial aneurysm undergoing interventional therapy at the Department of Neurosurgery, Liaocheng People's Hospital. Clinical data questionnaire was applied to collect the clinical data of patients. Discharge readiness scale and discharge guidance quality scale were adopted to assess patients′ discharge readiness and discharge guidance quality. Pearson correlation analysis was used to analyze the correlation between discharge guidance quality and discharge readiness, while multi-linear regression analysis was used to analyze the influencing factors of discharge readiness. Results In this study, the total score of discharge readiness in patients with intracranial aneurysm undergoing interventional therapy was (157.90±26.98) points, which was at a moderate level. Pearson correlation analysis showed that the discharge guidance quality was positively correlated with the discharge readiness for patients with intracranial aneurysm (r=0.619, P<0.01). Multi-linear regression analysis showed that the education level, family average monthly income, place of residence, numbers of long-term medications required, and discharge guidance quality were factors influencing the discharge readiness of patients with intracranial aneurysm undergoing interventional therapy (β′=0.102, 0.175, 0.391, -0.226, 0.314, P<0.05). Conclusion In patients with intracranial aneurysm undergoing interventional therapy, the discharge readiness was at a moderate level, and the medical staff should make interventional strategies, taken the factors affecting the discharge readiness into consideration, and strength the discharge guidance quality to improve the patients′ discharge readiness and prognosis. Key words: Intracranial aneurysm; Discharge readiness; Discharge guidance quality; Influencing factors