The effectiveness of protocol drive, nurse-initiated discharge in a 23-h post surgical ward: a randomized controlled trial.

摘要

BACKGROUND: A 23-h unit was established in June 2005 to relieve pressure on surgical beds. Patients were to be discharged by 0900h without review by a doctor. However, discharge without review remained the exception rather than the rule. OBJECTIVE: The aim of the current trial was to asses the affect of a protocol driven, nurse-initiated discharge process on discharge time, patient satisfaction and adverse events. DESIGN: Randomised controlled trial. SETTING: A large, major metropolitan hospital in Queensland, Australia. PARTICIPANTS: Patients undergoing a surgical procedure and requiring an overnight stay in the 23-h unit were eligible for inclusion. 182 were randomised and 131 patients completed the study. METHODS: Participants were randomly assigned into one of two groups: protocol driven, nurse-initiated or usual care. The primary end-point was the proportion of patients discharged by 0900h. Patients completed a self-report questionnaire two weeks after hospital discharge, to evaluate their satisfaction. RESULTS: Of the 131 patients completing the trial, only 82 (62.6%) were discharged by 0900h. In the Protocol group 45 (78.9%) patients were discharged on time compared with 37 (50.0%) in the usual care group. This difference was statistically significant (OR 3.75; 95% CI-1.74-8.21; p=0.001). The average length of stay in the 23-h unit was 16.5(SD 6.8)h. This did not differ by group (MD 0.29; 95% CI-2.13-2.71; p=0.81). The overall mean satisfaction score was 95.4 (SD 8.8) and results were similar between groups (Protocol group 96.2 versus usual care group 94.6; p=0.40). CONCLUSIONS: A protocol driven, nurse-initiated discharge process in an overnight post surgery unit results in a higher proportion of patients being discharged by 0900h without compromising patient satisfaction.