Page 43 - Johns Hopkins Nursing Magazine Spring 2023 - Johns Hopkins School of Nursing

Nurses Lead the Charge to Early Discharge

BY EMILY GAINES BUCHLER

Plenty of holdups can get in the way of discharging discharge involves lengthy education on how to care
patients from the hospital in a timely fashion. for a catheter at home and what to expect in the
One patient might face a medication delivery healing process,” Massey explains, so she and her
delay, while another waits for imaging or lab results, colleagues start training patients the day before they
and a third needs time with a nurse for extensive are flagged for discharge.
discharge instructions.
Key to the initiative’s success, Travers says, is gathering
These and other impediments clog the flow of data and identifying bottlenecks in the discharge
incoming and outgoing patients at hospitals process. “We track every component, and nurses get
across the country, including The Johns Hopkins real-time data on potential impediments that they can
Hospital (JHH). use to troubleshoot,” she explains.

To improve the stream of beds available, Pete Travers, So far, the effort to equip nurses with the data they
the interim program director in bed management need to lead and coordinate the discharge process is
for JHH’s Capacity Command Center, worked with paying off—on 11 West, for example, an average of 17
an interdisciplinary team to launch the Aligned percent of patients previously left before noon. That
Early Discharge Initiative (previously known as Two jumped 37 percent in December 2022.
by Noon), a program that involves discharging two
patients on each hospital unit by noon every day. The In the Department of Medicine, “We’re seeing
initiative started with a staggered rollout in June patients move more quickly from the emergency room
2022, beginning with Zayed 11 East, where patients to a private hospital room, where they can get more
recuperate from orthopedic, spine, trauma-related robust care and ultimately have a better outcome,” 41
and general surgery; Zayed 11 West, the recovery unit Travers says. “We’re also seeing a decompression of
for urology and thoracic surgery; and Zayed 10 West, intensive care unit beds,” meaning that intensive care
the cardiovascular progressive care unit. Eventually, unit patients can move to lower levels of care once
Travers and her team plan to implement the Aligned ready. This, in turn, frees up spots for other critically
Early Discharge Initiative across the entire hospital. ill patients.

Most hospitals have an overarching discharge strategy, The Aligned Early Discharge Initiative is also
but “what makes our plan unique is that nurses improving satisfaction rates for patients and families.
lead the charge,” explains Travers. “When a patient “No patient or family likes spending a longer amount
is identified as ‘early discharge,’ the nurse nudges of time in the hospital than is necessary,” says Massey.
individuals in other disciplines to complete their “Now, more patients can go home during daytime
part of the discharge hours, when there’s less traffic on the roads and it’s
process ahead of time, not dark out.”
instead of scrambling
at the last minute.” Plus, the initiative cuts down on “the huge bolus of
admissions and discharges that nurses often juggle
For Leigh Massey, a in the late afternoon or evening,” Travers adds. In this
nurse on Zayed 11 sense, the program helps make the workload of nurses
West, the discharge more manageable.
process involves
extensive patient “It’s like the saying goes: ‘A rising tide lifts all boats,’”
education. “Many Travers says. “When units hit their early discharge MAGAZINE.NURSING.JHU.EDU
of our patients targets, everybody benefits, creating a win-win for
have their prostate all involved.” ◼
removed due to
prostate cancer, and In photo at left, Edna (Pete) Travers.