Executive Summary

PPreparation of patients for discharge is a primary function of hospital-based nursing care and readiness for discharge is an important outcome of hospital care. Inadequacies in discharge preparation have been well-documented and linked to difficulty with self-management after hospital discharge and with increased likelihood of emergency department (ED) use and readmission. Prior studies by the research team have led to recommendations for implementation of discharge readiness assessment as a standard nursing practice for hospital discharge.

This study aims to test the impact of unit-based implementation of discharge readiness assessment on readmission and ED use within 30 days post-discharge. Three protocols, each adding a component to discharge readiness assessment, will be used to introduce, in sequence: (1) discharge readiness assessment by the discharging nurse; (2) discharge readiness assessment by the discharging nurse informed by prior patient self-report of discharge readiness; and (3) patient-informed nurse assessment, with the addition of an instruction to the discharging nurse to initiate and document nursing action(s) for patients with low readiness. Nurse and patient versions of the 8-item short form of the Readiness for Hospital Discharge Scale will be used for discharge readiness assessment.

The study uses a prospective, parallel cohort, stepped intervention design with four study steps (baseline and the 3 intervention steps) and two study conditions (implementation units and usual care control units). Difference-in-difference analysis will compare patient outcomes at baseline and each of the 3 implementation steps on the intervention units (first difference) to outcomes on paired control units (second difference), adjusting for hospital, unit, and patient-level control variables. The optimal implementation protocol will be identified through these methods. Cost-benefit analysis will calculate the net economic benefit of effects on postdischarge utilization outcomes, adjusting for recurring and non-recurring implementation costs. The results will provide evidence of the impact of a hospital nursing care process on post-discharge outcomes, with important implications for patient well-being and costs of care. Process evaluation will assess intervention fidelity and implementation context, facilitating broad translation as a standard of nursing practice for hospital discharge.