Purpose: The pandemic prevented the normal face-to-face care coordination rounds (CCR) thus the need to integrate technology to overcome the barrier and ensure unparalleled patient care. The project aimed to increase the number of patients discharge by 20% by implementing virtual CCR within twelve weeks.
Relevance/significance: Delayed discharge increases the length of stay and risk of hospital-acquired complications affecting morbidity and mortality and impacting health care cost. Daily CCR ensures that interdisciplinary team members review patients' care plan to enhance patient outcomes by identifying and addressing discharge needs. The pandemic posed a serious challenge in implementing patient care and coordination especially with the required social distancing and strict infection control protocols, but nurses are resilient and innovative. Nurses will develop innovative strategies to overcome barriers. Coordination of care is very important, and it is imperative to do daily CCR with or without pandemic. The implementation of virtual CCR facilitates continuous coordination and transition of care to home or another level of care.
Strategy/implementation/methods: VCCR was an innovative strategy to ensure consistent patient care coordination throughout the week even during the pandemic. Using Roger's diffusion of innovation theory, the team disseminated innovation efficiently and inexpensively to improve patient care using available resource and process integration. It was done daily with unit leaders facilitating remotely on weekends. The project was implemented for 12 weeks. Project activities included staff education and training on patient throughput and length of stay, discharge date projection based on diagnosis and medical milestone, and the VCCR process. Using run chart, the number of patients discharged, and LOS were monitored and analyzed.
Evaluation/outcomes/results: The VCCR increased the number of discharges and improved the average LOS from 7.10 to 6.76 meeting the goal of 0.99 LOS index. Even on weekends, the number of patients discharged increased from 3.87 to 6.83 during the 12 weeks of project implementation. Nurses reported satisfaction with the VCCR having the support from leadership in addressing throughout barriers even on weekends, receiving useful information in discharge planning and patient care, and immediate escalation process as needed. With the in-house charge nurse, the communication with on-call case manager and social worker for patients' discharge needs were communicated and addressed efficiently and effectively.
Conclusions/implications for practice: The VCCR project is an innovative strategy to facilitate safe and timely discharge of patients when face-to-face interactions were regulated. Evidence shows positive implications for practice of VCCR to ensure well-coordinated care, safe discharge process, and improved LOS. Reducing the LOS prevents patients from complications such as nosocomial infections and hospital-acquired injuries such as falls and pressure injuries, thus positively impacting patients’ safety and health care-related cost.
Evidence-based references 1. Bai, A.D., Dai, C., Srivastava, S., Smith, C.A., & Gill, S.S. (2019). Risk factors, costs and complications of delayed hospital discharge from internal medicine wards at a Canadian academic medical centre: retrospective cohort study. Retrieved from https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-4760-3 2. LaMorte, W.W. (2019). Diffusion of innovation theory. Retrieved from https://sphweb.bumc.bu.edu/otlt/MPHModules/SB/BehavioralChangeTheories/BehavioralChangeTheories4.html