Implementing an Inpatient Virtual Discharge Nurse Program – Riding the Wave of Technology at the Bedside

Necessity is the “mother of invention” and the COVID-19 pandemic has indeed spurred innovation and workflow redesign in order to transform healthcare delivery. Demand for inpatient acute care bed capacity has increased during the pandemic necessitating the discharge of patients earlier in the day to facilitate throughput. Responsively, in May 2020, nurse leaders and at a 1,200-bed Magnet® hospital identified an opportunity to leverage and optimize existing technology through a virtual discharge nurse (VDN) pilot on four medical-surgical units. This innovation utilizes an off-site nurse to remotely provide support for care tasks that may be completed with limited physical interaction. Goals of the VDN initiative are to conserve personal protective equipment (PPE), facilitate throughput, support the bedside RN and bolster the patient experience by efficiently attending to the education and care coordination needs evident upon discharge.

This presentation describes the implementation of a VDN initiative that informs attendees of valuable insights associated with the conference goal of sharing strategies and workflow design which utilize healthcare technology throughout the continuum of care to optimize patient outcomes and equip nurses to lead well in this new environment. Supported by Lewin’s model of change nursing, key tactics which enabled the launch of the VDN project from a 7-day period of idea to inception included assembling and engaging a group of interprofessional stakeholders from clinical informatics, staffing operations, and nursing leadership who defined the project’s scope, milestones, and created project inclusion and exclusion criteria. Current applications were evaluated and reconfigured to meet remote project needs and documentation tools in the electronic medical record were operationalized to increase the transparency of discharge readiness. Roles and responsibilities of the VDN were established, workflows created, scripted patient discharge information developed, existing off-site telehealth support engaged, and non-budgeted or redeployed staff positions were utilized. Crucial was the creation of provider/caregiver communication processes to avoid redundancy or gaps in care. Virtual patient discharges have expanded to eight medical-surgical units. One virtual nurse FTE was responsible for 4.8% of all discharges from the facility between May and November 2020 (731/15,338).

Preliminary findings reflected an average decrease of > 84 minutes from traditional discharges to VDN on pilot units, with encouraging trends associated with discharge order to complete times and virtual discharges completed before noon. Future metrics include 7- and 30-day readmission rates, length of stay, and staff/provider satisfaction. Next steps include expansion across workflows, locations and technologies and a request for formal, budgeted VDN positions. Information gained during this presentation can be incorporated within a wide variety of settings to utilize virtual care nursing to support continuity of care and meet the growing demands of patients and nurses. 

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.