Date of Award

5-2026

Document Type

DNP Project

College

College of Health & Human Services

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Sara Kim

Second Advisor

Devorah Overbay

Abstract

Background

Timely and efficient patient discharge processes are crucial for enhancing hospital throughput, reducing emergency department boarding, optimizing inpatient bed utilization, and ensuring safe transitions of care. Delayed hospital discharges contribute to prolonged hospitalizations, operational inefficiencies, increased healthcare expenditures, and decreased patient satisfaction. Progressive care units (PCU) are particularly vulnerable to discharge delays because patients frequently require multidisciplinary coordination before safe discharge can occur.

Purpose

The purpose of this quality improvement project was to evaluate the effectiveness of implementing a structured discharge readiness checklist combined with an n-by-T discharge planning strategy during multidisciplinary patient progressive rounds (PPRs) to improve discharge efficiency in a 30-bed progressive care unit at a community-based acute care hospital in suburban South King County, Washington.

Methods

A quantitative pre- and post-intervention quality improvement design guided by the Plan-Do-Study-Act (PDSA) framework was utilized. The intervention consisted of implementing a discharge readiness checklist during multidisciplinary discharge planning rounds and establishing targeted discharge goals before noon using the n-by-T strategy. Outcome measures included discharges before noon (DBN), order to discharge (OTD) time, average discharge time, average length of stay (ALOS), and 7-day and 30-day readmission rates. Data were collected from the hospital’s Power BI database and analyzed using descriptive statistics, chi-square analysis, and Welch independent-samples t-tests.

Results

The project included 346 patient discharges, with 156 occurring during the preintervention and 190 during the post-intervention period. Following intervention, the percentage of discharges before noon increased significantly from 10.3% to 22.6%, c2(1, N = 346) = 9.28, p = .002. Mean order-to-discharge time improved from 4.00 hours to 3.29 hours, although the reduction did not reach statistical significance. Average discharge time improved by approximately 20 minutes, and average length of stay demonstrated favorable reductions. 7-day and 30-day readmission rates remained stable throughout the implementation period, indicating that improvements in discharge efficiency did not adversely affect patient safety outcomes.

Conclusion

Implementation of a structured discharge readiness checklist, combined with an n-by-T discharge planning strategy improved discharge efficiency, enhanced interdisciplinary communication, increased patient throughput, and supported operational effectiveness without increasing readmission risk. The project further demonstrates the value of systems-level quality improvement initiatives that integrate evidence-based practice, data-driven decision-making, interdisciplinary collaboration, and organizational leadership to improve health care delivery outcomes and operational performance.

Subject Area

Patient discharge instructions; Hospitals--Admission and discharge; Total quality management

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