Discharge Lounge and the Journey to Excellence in Patient Satisfaction
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Session F presented Friday, September 15, 2017
Purpose: Our Emergency Room(ER) patient satisfaction baseline scores related to discharge instructions for FY 2016 were at 43.31%. Our fiscal year goal, however, was to receive a score of 51% (75th percentile) with an answer of “excellent” on the question, “How were your discharge instructions?” from the ER patient satisfaction survey.
Design: This quality assurance project was spearheaded by frontline staff. Ideas gathered from other healthcare system hospitals as well as a literature review, led to the implementation of best practices including: implementation of a discharge lounge, daily follow-up phone calls, a discharge checklist, and feedback voicemail line. A new staffing assignment was created and included assigning of a “discharge RN” responsible for the care of patients discharged from the lobby.
Setting: The setting for this project is a faith-based, non-profit, 351-bed, acute care hospital. The hospital’s 36-bed emergency room (ER) services the community with nearly 70,000 patient visits yearly from two counties, with an average daily census of 190.
Participants/Subjects: All ER staff participated in this project. A discharge committee(DC) consisting of six nurses, one Clinical Coordinator, one Physician’s Assistant, one Doctor, and the manager spearheaded project implementation and evaluation.
Methods: Implementation of a discharge lounge on February 1st, 2016 for patients seen and treated from Medical Screening Exam areas began after a successful discharge lounge pilot in the triage booths trialed in November, 2015. Education and collaboration across the care team enhanced quality and timely communication for patients discharged from the lounge. In addition, video education was developed for the annual simulation lab education (April 2016) explaining “The Good, The Bad, and The Ugly (or never do)” of discharge instructions for all nurses. Patients discharged from the beds are done by their primary RN. In June 2016, the DC committee had a first meeting with subsequent bimonthly meetings. A discharge checklist, on pink colored paper selected to catch the eye, was developed by the patient experience team and adjusted by the DC committee. The pink sheets are used for every patient. Collaboration with outside sister facilities led to the implementation of follow-up phone calls and a follow-up feedback voicemail line that allows patients to provide real time feedback of their experiences in the ER. Collection and evaluation of this information was conducted by DC committee. Additional auditing, rounding, development of adequate discharge training, identification of barriers, and troubleshooting is ongoing and integral for the overall discharge process. Meeting monthly score improvement is rewarded with on shift staff celebrations.
Results/Outcomes: Increasing scores for FY17 demonstrate a 47.6% average with monthly scores that meet or exceed the 51% goal. A celebrated peak score of 54.4% occurred in the month of September.
Implications: Ongoing development of best practices specific to this ER demonstrates improvement in patient satisfaction scores month to month. From gathering of shared information and the literature, there was no noted standard that may work for every population. The ideas and interventions implemented for this successful project may be replicated by other facilities that are also on the journey to improving patient satisfaction.