Date of Award

4-10-2023

Document Type

Capstone

Degree Name

Doctor of Nursing Practice (DNP)

School Name

Donna and Allan Lansing School of Nursing and Health Sciences

Department

Nursing

Major Advisor

Dr. Heather Owens

Second Advisor

Dr. Barbara Jackson

Third Advisor

Dr. Angie Banet

Abstract

Increased length of stay (LOS) is a focus in hospitals as it has implications for decreased quality of care, increased cost of care, and results in care delays for other patients (Rojas-Garcia et al., 2018). LOS is a measure of a hospital’s efficiency and throughput, which is the process of admitting, treating, and discharging patients. Micallef et al. (2020) found a longer LOS can occur from having extra days due to inefficiency in delivering care or from delays in discharge once the patient no longer needs acute care. The longer a patient stays in the hospital, the greater the risk they will develop a healthcare-acquired condition which may lead to a higher mortality rate. These patients also decrease the hospital’s throughput by blocking the admission and treatment of other patients. Additionally, hospitals are generally not reimbursed for providing the additional days of care since hospitals are reimbursed on a prospective payment system (CMS, 2019). A review of the literature confirmed a great interest and genuine need to identify interventions to address hospital LOS and delayed discharges. While the evidence was generally low to moderate for the multiple interventions studied to address the issue, there were strong recommendations to continue work in this area including efforts to improve patient centered discharge planning (Cadel et al., 2021; Feldman et al., 2022; Micallef et al., 2020; Rochester et al., 2018; Rojas-Garcia et al., 2018; Tipton et al., 2021). Incorporating discharge checklists and communication processes with standardized procedures can improve discharge preparations and be helpful in preventing discharge delays.

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