Abstract
Background: Prolonged hospital stays in cardiac telemetry units contribute to patient dissatisfaction, elevated risk of complications, and increased healthcare costs. Inefficiencies in discharge planning, including poor communication, inadequate team coordination, and late identification of discharge barriers, are primary drivers of unnecessary length of stay (LOS) extensions in specialized cardiac units.
Local Problem: On a 36-bed cardiac telemetry unit at a 314-bed Magnet-accredited hospital in North Texas, recurring discharge delays were identified through performance data, nursing and case management feedback, and internal quality metrics. A baseline mean LOS of 4.58 days and a Discharge Before-Noon (DBN) rate of 12.43% reflected persistent inefficiencies in the current discharge planning process.
Intervention: Structured multidisciplinary discharge rounds (MDRs) were implemented on the unit, convening nursing, medical staff, case management, rehabilitation therapy, and ancillary staff daily 2 to proactively identify and resolve discharge barriers. An afternoon loop closure check at 2:00 p.m. was added to verify the status of same-day discharge progression.
Methods: A quality improvement design was used with a pre/post intervention comparison. The 12-week implementation period ran from January 6 through April 6, 2026, with a baseline period of October through December 2025. Data were extracted from the Epic electronic health record (EHR). Primary outcome measures included mean LOS and DBN rate, while MDR participation was monitored as a process measure. Staff satisfaction with discharge workflow efficiency, HCAHPS Discharge Information scores, and 30-day readmission rates were monitored as balancing measures. An independent samples t test was used to assess the LOS difference; remaining outcomes were analyzed descriptively.
Results: Mean LOS decreased from 4.58 days (baseline, n = 555 discharges) to 3.32 days (implementation, n = 580 discharges), a 17.25% reduction (p < .05). DBN rate improved from 12.43% to 35.6%, a 186% relative improvement. MDR participation reached 97%. Staff satisfaction with discharge workflow efficiency increased from 80% to 95%. Discharge order-to-departure time trended from a baseline mean of 258.3 minutes to two hundred minutes by Week 12 and 195 minutes post implementation.
Conclusions: Structured MDRs were a feasible, effective, and staff-supported strategy associated with improved discharge planning efficiency in this cardiac telemetry setting. Findings aligned with organizational throughput goals and a Magnet culture of evidence-based practice and supported consideration of the model for adaptation in other inpatient units
Date of publication
Fall 12-11-2026
Document Type
DNP Scholarly Project
Language
english
Persistent identifier
http://hdl.handle.net/10950/5199
Committee members
Dr. J Michael Leger, Dr. Emily Fox, Dr. Angie (Mary) McInnis, Dr. Jeni Chilton
Degree
Doctor of Nursing Practice
Recommended Citation
Onubuike, Beatrice N., "DNP Final Report: ENHANCING DISCHARGE PLANNING TO REDUCE PROLONGED HOSPITAL STAYS ON A CARDIAC TELEMETRY UNIT USING STRUCTURED MULTIDISICIPLINARY ROUNDS" (2026). DNP Final Reports. Paper 106.
http://hdl.handle.net/10950/5199