Date of Conferral

2019

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Eric Anderson

Abstract

Extended hospital length of stay (LOS) causes increased health care costs and incidence of never events, such as hospital-acquired infections, pressure ulcers, and falls, which are not reimbursed by Medicare. This study examined if there would be a statistically significant decrease in the LOS of patients after the implementation of a discharge process improvement initiative (DPII), The model for improvement and small tests of change concept were used to guide the DPII at a hospital in northern California. Sources of data included archival data obtained from the hospital's quality improvement department that showed LOS prior to and after the implementation of the DPII. The LOS for 2015 and 2017 were compared using the t test for independent samples. The LOS in 2015 was longer (M = 4.59, SD = 3.66) than in 2017 (M = 4.09, SD = 3.81), a statistically significant difference, M = 0.50, 95% CI [0.32, 0.67], t (77) = 5.574, p = .005, d = 1.3, showing that the implementation of the DPII led to a reduction in the LOS. This reduction cannot be attributed solely to the DPII because other projects were implemented at the same time, such as the Clinical Decisions Unit and multidisciplinary rounds. Future research could focus on the relationship between reduced LOS and readmission and the degree of collaboration among health care team members. The implications of this study for social change include the potential to lower health care costs and increase patients' awareness of their responsibility for their own health.

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