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Authors

  1. Bobay, Kathleen PhD, RN, NEA-BC
  2. Bahr, Sarah J. MSN, RN, ACNS-BC
  3. Weiss, Marianne E. DNSc, RN
  4. Hughes, Ronda PhD, RN, FAAN
  5. Costa, Linda PhD, RN, NEA-BC, FAAN

Abstract

OBJECTIVE: The aim of this article is to describe how the discharge preparation process is operationalized in Magnet(R) hospitals.

 

BACKGROUND: Nationally, there are intensive efforts toward improving discharge transitions and reducing readmissions. Discharge preparation is a core hospital function, yet there are few reports of operational models.

 

METHODS: This was a descriptive, Web-based survey of 32 Magnet hospitals (64 units) participating in the Readiness Evaluation and Discharge Interventions study.

 

RESULTS: Most hospitals have adopted 1 or more national readmission reduction initiatives. Most unit models include several discharge preparation roles; RN case managers, and discharging RNs lead the process. Nearly one-half of units actively screen for readmission risk. More than three-fourths report daily discharge rounds, but less than one-third include the patient and family. More than two-thirds report a follow-up phone call, mostly to assess patient satisfaction.

 

CONCLUSIONS: Magnet hospitals operationalize discharge preparation differently. Recommended practices from national discharge initiatives are inconsistently used. RNs play a central role in discharge planning, coordination, and teaching.