The purpose of this paper is to introduce an early discharge education program that aims to reduce the number of post-operative calls for nurses. This program addresses a common issue that impedes the workflow of nurses at Forest Hills Medical Services. More specifically, in their first days after completing the in-patient phase of the treatment, the center’s patients often develop new complications. In addition, they retain the need for medical assistance even their condition does not deteriorate during this stage. As a result, these patients call nurses to visit them or provide consultation through phone calls. Furthermore, such cases may also lead to readmissions, increasing the stress on the center’s capacity. In this regard, a program is proposed to provide Forest Hills’ nurses with post-operation care insights that will help them build patient autonomy upon the latter’s discharge from the facilities. This way, the workflow of the nurses will be optimal, allowing them to concentrate on the current in-patient objectives without frequent distractions.
The phase of post-operative interaction with the patient, especially post-discharge, receives the increasing attention of experts and researchers in the field of nursing. For Liu et al. (2018), the most serious impact of flaws at this stage consists of hospital readmissions. They suggest that the presence of such an outcome implies that pre-discharge and early discharge communication was not performed effectively. In many cases, nurses do not possess the required expertise to prepare their patients for the end of the in-patient treatment phase. Before discharge, most of the patients’ needs are met with the efforts of the nurses. Then, once the time comes for them to be sent home for further recovery, patients lack the skills required for efficient self-care. Liu et al. (2018) note that 67% of them return to the medical facility before their next scheduled visit. This tendency is alarming, as it implies that patients are simply unprepared for the post-discharge phase.
The lack of preparedness, if understandable, as the post-operative stage is associated with concerns regarding one’s own health. Patients worry about possible complications or various recovery impediments, which prompts them to contact nurses outside the scheduled interaction. As per the article by Stamenkovic et al. (2018), most surgical interventions cause severe patient anxiety, which starts from the pre-operative stage and persists throughout recovery. In the most serious cases, this mental condition even contributes to increased patient mortality. In this regard, an emphasis should be laid on the educational component of the patient-nurse interaction with the intent to eliminate the anxiety. On a larger scale, this intervention should contribute to the reduced number of post-operative calls, allowing the communication to remain within scheduled limits. Kang et al. (2018) concur, highlighting the risks of insufficient discharge education as the primary cause of healthcare system stress and increased readmission rates. The emphasis is to be on the first 30 days of the post-operative discharge as the key determinant of recovery’s outcome. However, if the nurses are expected to provide this education to their patients, they should be properly educated in this regard first.
The proposed program aims at providing nurses with the required knowledge that will help them form the required framework of post-operative communication. The ultimate outcome of it will benefit both sides, as patients will be able to overcome anxiety and ensure self-care, while the nurses can concentrate on their ongoing affairs. The importance of the project is justified by the fact that post-surgical care can be compromised if a nurse is forced to partake in excessive post-operative calls (Bhandari et al., 2022). The process of its implementation will revolve around providing nurses engaged in pre- and post-surgical care with the knowledge of effective post-discharge education (Koivisto et al., 2020). More specifically, upon completing the program, they will be able to mitigate patient anxiety and deliver comprehensive guidelines on the recovery process.
For this purpose, the project’s leaders will start by observing nurses’ behavior during the key phases of post-op treatment. The flaws will be identified and analyzed from the perspective of the most efficient ways of their mitigation. In addition, the post-discharge call logs from patients will be analyzed in terms of their frequency and contents. This way, it is possible to determine the primary factors that prompt patients to make those calls. While surgical anxiety is the underlying issue behind this trend, it is valuable to know the exact occurrences and concerns that finally make the patient call the hospital. As a result of this process, a categorized list of factors will be obtained. Next, nurses will be taught how to address these key manifestations of post-surgical anxiety before the patient leaves the premises of the hospital. This includes basic knowledge of how the recovery process is expected to proceed. For example, the normal frequency of pains and the projected time for the full healing of sutures. Ideally, a nurse should be able to explain to their patients the line between normal post-surgical effects and complications.
However, as identified prior, a nurse should possess this knowledge themselves, while also having the required skills to build effective communication. The outlined project will meet these criteria, and it is expected to be feasible in the economic sense, as well. The initial budget estimations, presented in Appendix B, are within $1,000. This way, Forest Hills Medical Services will see a significant increase in the quality of care with reasonable expenditures. The effects of the project implementation will be long-term and sustained, positively affecting the financial situation of the center.
References
Bhandari, N., Epane, J., Reeves, J., Cochran, C., & Shen, J. (2022). Post-discharge transitional care program and patient compliance with follow-up activities. Journal of Patient Experience, 9.
Kang, E., Gillespie, B. M., Tobiano, G., & Chaboyer, W. (2018). Discharge education delivered to general surgical patients in their management of recovery post discharge: A systematic mixed studies review. International Journal of Nursing Studies, 87, 1-13.
Koivisto, J. M., Saarinen, I., Kaipia, A., Puuka, P., Kivinen, K., Laine, K. M., & Haavisto, E. (2020). Patient education in relation to informational needs and postoperative complications in surgical patients. International Journal for Quality in Health Care, 32(1), 35–40.
Liu, X., Hu, M., Helm, J. E., Lavieri, M. S., & Skolarus, T. A. (2018). Missed opportunities in preventing hospital readmissions: Redesigning post-discharge checkup policies. Production and Operations Management, 27(12), 2226-2250.
Stamenkovic, D. M., Rancic, N. K., Latas, M. B., Neskovic, V., Rondovic, G. M., Wu, J. D., & Cattano, D. (2018). Preoperative anxiety and implications on postoperative recovery: What can we do to change our history. Minerva Anestesiologica, 84(11), 1307-1317. Web.
Appendix A: Scope Statement
- Organization’s Name: Forest Hills Medical Services/Vivaeve
- Project’s Name: Early Discharge education to reduce number of post-op calls.
- Project Manager:
- Sponsor(s), Title: Early Discharge education to reduce number of post-op calls.
- Organizational Priority (High, Medium, Low): Medium.
- Mission Statement:
- Measureable Project Objectives – (Use 5 W’s and H. Sipes, 2016):
- Who: Pre-op and PACU Nurses, Director of Nursing, Patients and families.
- What: Increase number of post-op calls.
- Where: Pre-op and PACU areas.
- Why: Taking nurses away from bedside to follow up with phone calls.
- When: Procedure days (Saturday and Sunday).
- How: Early discharge education.
- Justification of Project: Postsurgical care can be compromised when RN need to follow with high number of post op calls.
- Implementation Strategy: By educating, observing, and evaluating nurses thru the peri-op phases.
- Project Resources – Human and Technical: Nursing, post-op calls records/log, evidence -based resources like nursing journals and research information.
- Completion Date:
- Post-op calls log, comparing numbers of post op calls.
- Measures of Success – Include all Metrics: Obtaining and comparing Post-op calls records/log from prior project date to after.
- Assumptions: The project will be considered a success when the number of post-op calls decreases.
- Constraints:
- Patients’ families not available to participate in early discharge education.
- Budget.
Appendix B: Practicum Project Charter
- Project Title: Early Discharge education to reduce number of post-op calls.
- Project Start Date: Project End Date:
- Project Manager:
- Budget Information:
- Total of $900.
- Supplies (paper goods) $100.
- Nurses educational luncheon $350.
- Educational material design $250.
- Hand-out printing $200.
- Measurable Project Objectives – (Use 5 W’s and H. Sipes, 2016):
- Who: Pre-op and PACU Nurses, Director of Nursing, Patients and families.
- What: Increase number of post-op calls
- Where: Pre-op and PACU areas
- Why: Taking nurses away from bedside to follow up with phone calls
- When: Procedure days (Saturday and Sunday)
- How: Early discharge education.
- Approach: Starting discharge education in pre-op and peri areas instead of waiting to get to PACU
- Roles and Responsibilities:
- Director of Nursing – Facilitates project execution
- Nurse Manager – Facilitates new initiatives by in servicing nursing staff
- Pre-Op Nurses – Starts early discharge education and shares information with family
- PACU Nurses – Reinforces Discharge education as needed
- Comments (from each of the stakeholders listed in the Roles and Responsibilities).