Date of Conferral

2-10-2026

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Corinne Romano

Abstract

This Doctor of Nursing Practice (DNP) executive leadership systems improvement program presents the design of an evidence-based intensive outpatient program (IOP) in a community psychiatric clinic in the central region area of Maryland, to address the practice problem of fragmented transitions from inpatient psychiatry to routine outpatient services. This practice gap contributes to avoidable 30-day readmissions and prolonged emergency department boarding. The guiding practice question was as follows: In behavioral health organizations, how does a leadership-driven IOP implementation affect care transitions, staff engagement, and protocol adherence compared with existing discharge workflows? Local organizational indicators reveal elevated psychiatric readmission rates and significant capacity constraints, underscoring inefficiencies in current discharge processes. At the community level, one county in Mid-Atlantic state faces additional pressures, with approximately 410 residents per mental health provider and an average of 4.1 poor mental-health days per month. Key recommendations for successful implementation include a phased rollout to minimize disruption, standardized discharge protocols to ensure consistency, integration of telepsychiatry to expand access, incorporation of family therapy to strengthen engagement. A targeted literature review was conducted, the search yielded 11 relevant articles, all appraised using the Johns Hopkins evidence-based practice model appraisal tools. Evidence levels ranged from Level II to Level V, with most studies rated Level III, good quality, and two studies rated Level II–III, good quality. Findings consistently demonstrated that IOPs reduce emergency department utilization and rehospitalizations. The major products developed for this project include a comprehensive implementation plan on a detailed budget, an evaluation plan, a logic model, a team charter, and an organizational alignment table enhancing patient and staff outcomes. The nursing practice implications include expanding the role of registered nurses in leadership, care coordination, and the application of measurement-based care. The initiative to streamline transition from inpatient to outpatient services has potential to increase equitable access to culturally responsive services, which foster positive social change.

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