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Evidence-based nursing: Can a preflight checklist make hospital discharge safer?
Alison Trembly DNP, RN, APN

Nursing Management
January 2013 
Volume 44  Number 1
Pages 8 - 11
  PDF Version Available!

Hospital discharge is a complex, high-risk transition for patients and their caregivers. Within the first 30 days after hospitalization, one in five patients experiences an adverse clinical event, such as: a medication error, a fall, or a hospital-acquired infection; seeks care at an ED; is readmitted; or dies.1 The rapid growth of the hospitalist model of care magnifies safety and quality issues at discharge because inpatient care is provided by physicians and clinical teams who have no previous or subsequent care relationship with the patient. In 2006, only 31.9% of hospitalized Medicare beneficiaries had their care directed by their own primary care provider, compared with 44.3% in 1996.2 The high economic and human costs of postdischarge complications are a major focus of attention for patient safety and advocacy groups, The Joint Commission, and private and governmental insurers.3The author of this article, a nurse practitioner on an adult hospitalist service at an academic, tertiary medical center in New Jersey, performed a review of the evidence and then developed a clinical tool for use by hospitalist teams, including physicians, advanced practice RNs (APRNs), physician assistants, and medical trainees, to improve the safety and quality of discharge from hospital to home. The integrative review method was used to identify, analyze, and synthesize best evidence on the topic. The theoretical framework for the study was patient-centered care, and the primary outcomes studied were patterns of healthcare utilization and adverse patient events during the discharge transition (generally, the first 90 posthospital days).4 Key findings were then incorporated into a discharge checklist that was pilot-tested by physicians, APRNs, and medical residents.There are widespread problems with hospital discharge as currently practiced in the American healthcare system, which are associated with a significant rate of patient harm and enormous economic costs. (See Figure 1.) Many

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