Background: Medically stable patients with barriers to discharge in the acute care setting are a growing proportion of hospitalized patients throughout the nation at a time when many hospitals are experiencing both bed and healthcare worker shortages. These patients remain bedded across various acute units in the hospital, reducing bed availability and staffing for more acute patients, and impacting overall resource utilization and health care costs. Despite the increasing proportion of hospital beds being used by medically stable patients, there is a paucity of research and/or guidelines for solutions to this national crisis.
Purpose: The purpose of this quality improvement project was to implement a patient care delivery model targeting medically stable adult patients in the acute setting in order to improve patient flow and bed availability.
Description: This quality improvement project was conducted at a Midwestern academic medical center with 809 inpatient beds across 2 hospitals and was focused on adult patients in acute care units who had been identified as having a delay in their hospital discharge. The acute care unit patients with delayed discharge disposition associated with complex needs and barriers were the focus of implementing a targeted care intervention. An interprofessional team evaluated data on those patients with delayed hospital discharge to determine the medical and nursing care needs of the targeted cohort of patients. Data findings indicated the delayed discharge population was medically stable, with lower nursing acuity than other “acute” care patients. The interdisciplinary team implemented a dedicated care delivery model called the Acute Transition (AT) Care Program by designating and staffing a 20-bed nursing unit using a staffing model, realigned nursing interventions and assessments for medically stable adult patient, thereby allowing for an increase in the nurse-to-patient ratios.The implementation of the AT Care Program required the delineation of a) AT Care unit patient eligibility, b) AT program patient order set, c) nurse staffing model for the AT Unit. The continued evaluation of acute care patients is conducted daily using the eligibility criteria for the AT unit program by charge nurses to facilitate timely use of the AT Unit for medically stable patients with delayed hospital discharge
Conclusions: The implementation of the AT Care Program delivery model resulted in: a) patient safety (no adverse events for AT Care unit patients), b) nurse satisfaction associated care and workload of patients on AT care unit and c) cost-savings associated with reduced nursing hours of care.