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The Family Centered Care Unit (FCC-3) at INOVA Fairfax Hospital (IFH) experienced a sharp decline in patient satisfaction and a few “near missed’ and missed safety events in the 3rd quarter of 2008. After reviewing all of the impacting factors, a Discharge Coordinator Program (DCP) was created to increase patient satisfaction and to ensure patient safety. The DCP removed a nurse from staffing whose main objectives are to provide an individualized plan of care for each patient, coordinate with the primary nurse to reallocate patient assignment and to check all charts to ensure patient safety needs have been addressed prior to discharge.

Every patient is given a teaching plan checklist, they are instructed to pick topics that they feel are relevant to their discharge.  The topics are then reviewed with the family, encompassing the FCC model and also are given a written personalized teaching plan.  The Discharge Coordinator (DC) performs post discharge phone calls to gather timely feedback for practice changes.  The primary RN is able to utilize their time with the patient more effectively without increasing the cost of manpower. Patients and families are more satisfied when education is tailored to their needs. In a unit with a high patient turnover rate, the streamlined DCP promotes the effectiveness of patient learning as well as improves the efficiency of workforce management.

This discharge process has armed patients with a plethora of relevant information that addresses their individual learning needs.  The double checking system ensures that no steps are missed in patient safety. The post discharge phone call provides invaluable data and has led to a refinement in team safety rounding practices as well as alternate education methods. It is after these phone calls that we found that the Spanish speaking patients left the hospital with several unanswered potentially dangerous questions. This provided for great concern and through this a Spanish speaking discharge class evolved.  As the program matured, it has been standardized and expanded to all FCC units to provide service 7 days a week for both English and Spanish speaking patients.

The DCP is useful to units with high patient turnover rates. By effective re-arrangement of the nursing workforce, this program allows nurses to spend more time with their patients, ensures the quality of patient care and increases patient satisfaction and patient safety. Returning patients have expressed their appreciation for this change.  Physicians have embraced the discharge coordinator program and now seek the DC’s for information.  The wait for discharge clearance has decreased, thereby decreasing length of stay along with a decrease in spending of budgeted supplies. The preliminary data shows an improvement in patient satisfaction survey. The excellence ranking has risen from the 66.6 to 81.3 percentile in 2 quarters since its inception. There have been no serious safety events noted and timely discharges have been observed. The program is currently being piloted at another INOVA hospital on their postpartum unit and on two other short-stay medical-surgical units as well.