Implementation of a Modified Early Screening for Discharge Tool to Optimize Case Manager Efficiency and Impact Length of Stay.

PURPOSE OF STUDY: The postacute landscape has been challenged since the onset of the COVID-19 pandemic by staffing shortages and a decline in postacute bed availability. As a result, patients in acute care hospitals are experiencing longer lengths of stay (LOS) and case managers (CMs) are managing increasingly complex discharge plans. This project involved the design and implementation of a modified Early Screen for Discharge Planning (ESDP) tool to support prioritizing patients with complex discharge needs, with the primary outcome of decreasing LOS. PRIMARY PRACTICE SETTING: The project took place in a community teaching hospital, part of a large academic health system in the Northeast, United States. METHODOLOGY AND PARTICIPANTS: The project was designed as a prospective controlled study (between September 1 and November 30, 2021) with defined intervention and control cohorts, involving a modified ESDP electronic health record-based score including self-rated walking limitation, age, prior living status, and mobility level of assist. A modified ESDP score of 10 and greater indicated that patients would benefit from ongoing CM support, whereas those with an ESDP score of less than 10 were unlikely to have discharge planning needs. Participants were adult patients on medical and surgical inpatient units. RESULTS: The project included 718 patients, 376 and 342 in the intervention and control cohorts, respectively. The modified ESDP performed comparably with the standard ESDP (14% discrepancy, with all patients appropriately identified for CM services). Implementation of the modified ESDP led to 53.5% of patients screening out of CM services, thereby increasing the time CMs were able to spend on complex discharge planning and was associated with a trend in LOS reduction (0.55 days). IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: The findings of this project demonstrate that implementation of a modified ESDP can improve CM efficiency and improve hospital throughput. Given the unprecedented capacity challenges in both the acute and postacute settings, there is a need to implement CM workflow strategies that will optimize the effectiveness of critical resources, while ensuring that patients' complex discharge needs are met.

Asking for Feedback: Clinical Nurses' Perceptions of a Peer Review Program in a Community Hospital.

OBJECTIVE: The purpose of this study was to understand clinical nurses' perceptions of their participation in a formal, annual peer review process at a metropolitan community hospital. BACKGROUND: Peer review is an essential component of professional nursing practice for self-regulation of the practice and promotion of quality and safety. Robust empirical evidence of formalized and effective peer review nursing processes is not evident. METHODS: A descriptive qualitative study with focus group interviews was used. RESULTS: Study results validate that peer review is a meaningful and valuable process used by clinical nurses to support professional growth and development. Nurses reported using their specific peer feedback as part of their annual goal setting. CONCLUSIONS: Results validate the importance of implementation of a structured, formal peer review process at the organizational level. The study findings identify that the essential components of an effective peer review process include education for peer facilitators and clinical nurses; dedicated time, space, and privacy to conduct peer reviews; and leadership support.

Using career nurse mentors to support minority nursing students and facilitate their transition to practice.

The Clinical Leadership Collaborative for Diversity in Nursing was developed through an academe-service partnership focused on supporting minority nursing students and facilitating transition to practice. A key program element is mentoring. Students are paired with an experienced, minority clinical nurse or nurse leader from one of the partnering agencies, who helps guide the student throughout the junior and senior year of school and first year of employment. The mentoring component was evaluated through surveys in which mentors and mentees rated one another and offered open-ended comments on the program's impact. Aspects of mentees rated highest by mentors include manner (courteous and professional), ability to communicate and get along with others, preparation for meetings, and fully utilizing their time with mentors. Aspects of mentors rated highest by mentees include warmth, encouragement, and willingness to listen; enthusiasm for nursing and how they sparked the mentee's interest; and clarity regarding expectations for mentees and how they pushed mentees to achieve high standards. In the open-ended comments, mentees consistently identified mentoring as the program's strongest component. Sixty-four minority students have participated to date with a zero rate of attrition and very low job turnover among graduates.