Improving the discharge process by embedding a discharge facilitator in a resident team.
The disturbingly high incidence of readmissions after hospital discharge remains a national policy priority, as many readmissions can be linked to adverse events after discharge. In this study, a nurse practitioner (NP) was assigned to a resident inpatient medical team at a tertiary care hospital, with the specific responsibility of facilitating the discharge process. The NP's responsibilities included arranging follow-up appointments, performing medication reconciliation, and following up on tests pending at discharge. Although NP discharge facilitation achieved improved patient satisfaction with the discharge process, higher rates of timely outpatient follow-up, and improved resident work efficiency, it did not result in fewer readmissions or emergency department visits in the post-discharge period. The complex nature of preventing readmissions is discussed in an AHRQ WebM&M interview with Dr. Eric Coleman.