Improving Discharge Practice in the Emergency Department to Prevent Return Visits 1 IMPROVING DISCHARGE PRACTICE 2 Improving Discharge Practice in the Emergency Department to Prevent Return Visits Project purpose The purpose of this project is to enable the implementation of a clinical intervention to ensure a reduction in the return visits to the emergency department. The proposed intervention is to implement a discharge checklist tool that when patients are going to be released from the emergency department, they can check mark boxes of what they understood from the discharge instruction packet. Then patient will need to sign affirming that providers discussed what is on the agenda with the patients before they leave the emergency department. The provider will verify what topic the patient did not understand and go over it once again and provide literature of the material given. The provider will be required to also sign this tool, stating that patient understood discharge instructions and that all topics were covered. This checklist tool will be place in patient’s medical records. The expected outcome and evaluation of this activity will be determined by the extent to which the patients understand the instructions. The effectiveness of this intervention will be manifested in the improvement of service delivery. The strategy is expected to reduce the overcrowding at the emergency department and improvement of the patient outcome. Additionally, nurses are they key for this tool since they are in direct contact with patients. They, subsequently, have specific errands, which are the main drivers of overcrowding. The issue of the patients to comprehend release guidelines can be tended effectively by nurses (Sayah et al., 2014). IMPROVING DISCHARGE PRACTICE Assignment Discussion

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They handle all the vital techniques of guaranteeing that patients are released from the hospitals, which incorporates all the desk work that should be shown to the patients, their parents, or relatives. Nurses can grasp this opportunity to clarify in detail every one of the inquiries that the patients of guardians pose and, in any event, asking IMPROVING DISCHARGE PRACTICE 3 them questions to guarantee that they understand the data they are given in detail. They can also step up to the plate by ensuring the transportation of the patients from the ED to their destinations, particularly when utilizing the ambulatory services. Nurses are in a better position to partake in clarifying the concerns of the patients as well as their diseases. This intervention can guarantee that patients stick to every one of the mandates of the directives of the care providers to maintain a strategic distance from occurrences arising from wrong medication. It should be fortified with legitimate ED training on patient management to prevent future returns. Intensive training can improve the role of nurses and incorporating patient engagement. These efforts can guarantee that providing a high-quality discharge process, it initiates the preparations for patients to return home and can properly manage their recovery without having the necessity of returning to the ED, thus reducing congestion Expected project outcomes By educating doctors, mid-levels providers and nurses on how to utilize the discharge tool they should be able to provide a high-quality discharge instruction to the patients. Most importantly, once individuals have been educated on the appropriate way to discharge a patient from the ED, it can be assumed these patients will continue to seek care accordingly. The implementation of the strategies above is expected to achieve the following outcomes. • Reduce or possibly eliminate unnecessary returns visits to the emergency department. • Improve the quality of care being offered at the emergency department. • Improve patient satisfaction. • Improve the competence of the doctors, mid-levels providers and nurses. Background IMPROVING DISCHARGE PRACTICE 4 Although hospitals have been striving to cut the cost, the problem of return visits to the emergency department has not been completely addressed. Most hospitals in the state of Florida have been concentrating on reducing 30-day readmission with a few activities and intercessions (Centers for Disease Control, 2017). In Florida, it is estimated that 28% of the acute care visits and half of the hospital admissions emerge from the Emergency Department (ED) per the CDC (2017). The authorization of Patient Protection and Affordable Care Act 2010 has shown the requirement for coordinating patient care voice in structuring the conveyance of social insurance (Rising et al., 2014). The clarifications for patients to come back to the ED, the plausibility of future return, and the recurrent return can be obtained from the administrative information. Some basic variables have been related with high rates of readmission of patients to the ED. They incorporate low follow up care and language boundary that bars patients from understanding the discharge guidelines. Other variables include old age, non-ambulatory status, and absence of family support. IMPROVING DISCHARGE PRACTICE Assignment Discussion

These visits are not only cumbersome to the healthcare personnel, but also an important indicator of the quality of care. The hospitals ED constantly face the issue of restricted assets, high rates of patient admissions, aging populace, and deficiency of human services suppliers. Majority of the ED have gotten amazingly overcrowded leading to long delays in care which contributes negatively to the patients’ outcomes since they cannot get treated on time. Patients returning to the emergency department have medical issues that have either failed to go away or improve or have gotten worse. Being an important metric to measure the quality of healthcare, the problem of unscheduled return visits to the emergency department is very important to healthcare or nursing since it provides the healthcare personnel with essential information regarding their performance or health output. A reduction in the rate of return visits IMPROVING DISCHARGE PRACTICE 5 to the ED is a marker of high-quality care, while an increase in the rate signifies poor healthcare performance and poor patient outcomes. Hospital emergency departments (ED) continuously face the problem of limited resources, increased patient presentation, aging population, and shortage of healthcare providers. Most EDs have, become among the most overcrowded sections of any healthcare facility. They are characterized by long waiting time that contributes negatively to the patients’ outcome as well as low family experiences. However, ideal nursing interventions can play a central role in preventing the overcrowding of the ED. Although hospitals have been striving to cut the cost, this goal has not been satisfactorily addressed because of the challenge of patients returning to emergency departments. Most hospitals in the state of Florida have been focusing on reducing 30-day readmission with several initiatives and interventions (CDC, 2017). In Florida, it is estimated that 28% of the acute care visit and 50% of the hospital admissions arise from ED per Center of Disease and Control (2017). The enactment of Patient Protection and Affordable Care Act and has demonstrated the need for integrating patient care voice in designing the delivery of healthcare (Rising et al., 2014). The explanations for patients to return to the ED, the possibility of future return, and the repeated return can be examined from the administrative data. Some common factors have been associated with high rates of readmission of patients to ED. They include low follow up care and language barrier that limits patients from understanding the discharge instructions.IMPROVING DISCHARGE PRACTICE Assignment Discussion

Other factors can be old age, no ambulatory status, and lack of family support. Advanced Practice Relationship This project has a close connection with Advanced Nursing Practice in that it provides nurses with an opportunity to perform their duties regarding patient discharge and patient care. IMPROVING DISCHARGE PRACTICE 6 Nurses assume a key role in transforming care. They can offer nitty gritty clarifications concerning patient discharge to the patients. It will involve the factors that will emerge while the patient will be at home, and how to move toward circumstances that may force them to return to the ED (Rafnsson & Gunnarsdottir, 2010). This will help keep the patients from heading off to the ED once more. Another transient arrangement includes the doctors examining itemized data about the diseases affecting their patients. The doctors can likewise appropriately address worries that their patients may need to lessen their vulnerability. Over the long haul, the doctors and attendants ought to guarantee they make an ED-based care program that will integrate the care teams in the ED. The program should offer more trainings on taking care of patients at the ED including the parts of release to prevent the return cases (Rushforth, 2015). Intensive training should point towards upgrading the nurses and doctor roles that incorporates patient engagement. Developing a discharge checklist that when patients are going to be released from the ED they can check out and sign affirming that providers examined what is on the agenda with the patients before they leave the ED. Doctors can fill in as a contact to different partners who practice by helping them discover the patients fittingly. Doctors ought to likewise work intimately with distinguished drug specialists associated to the hospital, to offer medication counselling. This will cultivate patient self-management and diminish vulnerability from patients (Schrader et al., 2019). DNP Essentials This DNP Project is supported by the DNP Essentials I, II and III. Essential I is the scientific underpinnings of this education which reflect the complexity of practice at the doctoral level and the rich heritage that is the conceptual foundation of nursing (AACN, 2006). The educational part of this project will assist healthcare providers to understand the patterning of IMPROVING DISCHARGE PRACTICE 7 human behavior in interaction with the environment in normal life events and critical life situations after being discharge from the ED. This will help improve science discipline by understanding the nature and significance of health and health care delivery phenomena. IMPROVING DISCHARGE PRACTICE Assignment Discussion

This essential also maintains that the extensive understanding of the nursing theory ensures that advanced nursing practice is built upon a solid foundation. Graduates can therefore integrate nursing practice with organizational or analytical sciences. These science-based concepts can therefore be used to improve the quality of healthcare. Essential II is the organizational and systems leadership to improve quality and systems thinking meaning that doctoral level knowledge and skills in these areas are consistent with nursing and health care goals to eliminate health disparities and to promote patient safety and excellence in practice (AACN, 2006). This essential helps in transforming research into practice. The project is based on quality improvement by making changes to current discharge policies by providing the best practice to discharge a patient. This will improve patient outcomes after being out of the ED and prevent them from returning because they didn’t understand discharge/after care instructions. Essential III states scholarship and research are the hallmarks of doctoral education (AACN, 2006). This essential mainly focuses on the complex issues that face modern health. It further focuses on the medical dilemmas that physicians face in patient care, as well as shaping the evidence-based initiatives in the agenda of healthcare. The project uses analytic methods to critically appraise existing policies and other evidence to determine and implement the best practice to discharge a patient from the ED. Essential IV allows the DNP to design by selecting, utilizing, and evaluating the programs that monitors outcomes of care, care system, and quality improvement including IMPROVING DISCHARGE PRACTICE 8 consumer use of health care information system (AACN, 2006). This project contains a significant analysis that involved patient’s quality of care and the utilization of patient care technology. Findings represent an opportunity to evaluate the return visits to ED for inappropriate discharge. Essential V refers to DNP engagement with the policy development by identifying the problem and creating a healthcare system that meets the needs (AACN, 2006). This project helps the DNP to educate others such as policy makers regarding patient outcomes, policy change, and the correct way of discharging a patient from the ED. Additionally, would address and facilitate health care needs in acute care setting. Essential VI states the importance of effective communication and collaborative skills in the development and implementation of practice models (AANC, 2006). The project demonstrates a collegiality within the community of knowledgeable people from different professions in heath care system with endeavors to serve the population by utilizing healthcare resources.IMPROVING DISCHARGE PRACTICE Assignment Discussion

Essential VII states the DNP is expected to evaluate care delivery models and the utilization of using concepts related to community, environment and occupational health, and cultural and socioeconomic dimensions of health (AACN, 2006). The project embraces the community to the extent of knowledge by supporting strategies directed to improve all dimensions of health. Additionally, supports the theoretical framework that is utilized to guide the project in the community as a whole. Essential VIII the DNP is expected a design, implement, and evaluate therapeutic interventions based on nursing science and other sciences (AACN, 2006). This project focuses on the established strengths and knowledge of the NP by applying them to the ability of the IMPROVING DISCHARGE PRACTICE 9 researcher of effectively evaluate, teach and educate individuals on the correct alternative provision of health care. This Essential shows the ability that the DNP demonstrate in advanced levels of clinical judgment such as systems thinking, accountability in designing, evaluating evidence-based care to improve patient outcomes. Target Population/Community The community of Celebration in Florida state is populous, which makes it an ideal area to create and execute the intervention. ED information in this state is robust, and this makes it less difficult to follow return visits. The population for this DNP Project is located in an acute care hospital in rural Central Florida. They have differing social foundations, which are primarily dictated by race. Among the social or cultural perspectives that prevail in the American culture can be ordered into whites, African Americans, Hispanic, Asians, Native Americans, and individuals with a mix of two races. The way of life of the objective populace impacts their wellbeing, convictions about ailments and demise, ways of life as well as health advancement. The psychosocial measurements can be ordered into three.IMPROVING DISCHARGE PRACTICE Assignment Discussion

Restorative measurements identify with the sort of treatment, the impression of misery, and the clinical course. Mental variables spread the interruption of life objectives and the capability of modifying life plans utilizing coping strategies and emotional stability. The social variables contain the accessibility of help from close partners, for example, companions, family, and colleagues. The ecological elements for the target population are critical in impacting the nature of their wellbeing and characterizing the fundamental preventive measures. According to Healthy People 2020, it is noted that 23% of all deaths in the world, just as 26% of deaths in kids under the age of 5, are contributed by natural factors that can be prevented (U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion [HHS ODPHP], 2018) IMPROVING DISCHARGE PRACTICE 10 . A portion of the elements that effect the target population incorporate environmental change, exposure to toxins in food, water, air and soil, the contamination of their habitats, and occupational dangers. The estimated demographic descriptors of the population are 49.1% male and 50.9% female and a median age of 35 for both genders. The population has an average family size of 3.14. The health literacy of the target population varies significantly according to race. For example, 14% of the whites are proficiency in health literacy IMPROVING DISCHARGE PRACTICE Assignment Discussion


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