RESUMO
Discharge is an important and complex process that can be optimized to reduce inpatient healthcare inefficiency and waste. This study aimed to increase the percentage of patients discharged before 1 pm by 20% from an academic inpatient pediatric gastroenterology service (IPGS), over 6 months. METHODS: We conducted a preintervention and postintervention study of patients discharged from IPGS. Patients discharged from January to June 2016, and those following our intervention from June to December 2016, were studied. Interventions included (1) implementation of the electronic medical record medical and logistical discharge criteria checklists for the 4 most common IPGS discharge diagnoses, (2) standardization of the rounds process to prioritize discharge, (3) education of nursing staff and families about the role they played in discharge. Process, outcome, and balancing measures were analyzed. RESULTS: Three hundred fifty-five total discharges were studied. Between the preintervention and postintervention groups, there were no significant improvements in discharge order time, physical discharge time, discharge response time, or discharges before 1 pm. The balancing measure of 30-day readmission was unaffected. However, length of stay (LOS) index, calculated as the ratio of actual to expected LOS, improved; when translated into days, LOS declined by 1 day, with potential associated savings of $373,000. CONCLUSIONS: Interventions to improve discharge timeliness on IPGS service demonstrated mixed effectiveness. Only LOS index improved. Further iterative quality improvement interventions are needed to continue optimizing discharge timeliness and change the culture of pediatric discharge on inpatient subspecialty services in academic children's hospitals.
RESUMO
BACKGROUND: Written communication skills are critical for nursing practice. However, nursing faculty often find students unprepared to communicate clearly and effectively in writing. This integrative review identifies and discusses specific approaches used in baccalaureate programs to teach writing skills to prelicensure nursing students. METHODS: Electronic databases PubMed, CINALHL, and ERIC were used. Nine articles were found describing programs that taught writing skills to prelicensure nursing students in baccalaureate programs. All articles were published since 1990 and met inclusion and exclusion criteria. Writing programs were divided into two categories: stand-alone programs and programs integrated across a nursing curriculum. Instructional strategies were analyzed to identify common elements. FINDINGS AND DISCUSSION: Five common elements of such programs were identified: short writing assignments, faculty training, sequential writing assignments, giving students examples of successful writing or explaining grading rubrics, and revision after faculty or peer feedback. Across-curriculum programs appeared to include these components more often than stand-alone programs. CONCLUSION: Writing programs implemented across a nursing curriculum may be more likely to include certain common components than are stand-alone programs. There is a critical need to measure both short- and long-term outcomes of these writing programs.
