This study evaluated the effectiveness of a change to an interprofessional discharge planning/teaching process with more patient and family engagement.
This study evaluated the effectiveness of a change to an interprofessional discharge planning/teaching process with more patient and family engagement.
A quantitative survey design was used to measure the effectiveness of the interprofessional discharge planning and teaching process in improving patient and provider outcomes.
The project used the Quality of Discharge Teaching (QDTS) and Readiness for Hospital Discharge Scale (RHDS) instruments to measure the patients' perceptions of readiness for discharge. Patient satisfaction rates were measured before and after the change.
The new interprofessional discharge planning/teaching process significantly improved patient satisfaction levels from pre- to postimplementation (p < .05). There were significant differences in both pre (n = 36) and post (n = 31) data for information needed as compared to information received (p < .05). Significant improvements were noted in total QDTS (p=.01) and the Expected Support subscale of the RHDS (p=.038).
The findings of this study indicate the importance of an interprofessional approach to discharge teaching to improve patient satisfaction and the quality of teaching. Adult learning theory and patient-centered care using a patient-engagement model is recommended for inpatient rehabilitation and home settings after discharge.
The trend toward shortened lengths of stay is well known in health care today (Popovic & Kozak, 2000). As patients transition between levels in the continuum of care, the experience affords less time for inclusive, collaborative, informed decision making among providers and patient engagement in patient-centered discharge planning and teaching. As a result, some patients discharged from acute rehabilitation to home may have greater physical and emotional needs than anticipated with increased family caregiver burden. There are numerous reports of patients’ inability to recall discharge instructions, lack of family caregiver confidence in their abilities to care for patients, and limits on access to services and resources that can help patients and families with the transition home (Forster, Murff, Peterson, Gandhi & Bates, 2003).
Although patient-perceived readiness for discharge may be influenced by many factors, research among adult medical–surgical patients has shown that the quality of discharge teaching is a strong predictor of a patient's perceived readiness for discharge (Weiss & Lokken, 2009; Weiss et al., 2007). A low perceived readiness for discharge was found to be a strong predictor of difficulty with postdischarge coping and readmissions.
The purpose of this evidence-based practice (EBP) change project was to evaluate the effectiveness of an interventional change to an interprofessional discharge planning/teaching process with more patient and family engagement to improve patient and provider outcomes as measured by satisfaction rates, patients’ perceptions of quality of discharge teaching, and readiness for hospital discharge. The intervention was named as the Discharge Process Acute Rehabilitation Transition (DePART). For this article, the term “patient” will include the patient and/or family caregiver. For some rehabilitation patients, the family members are not only the patient's support and advocate, but they also may be the patient's voice.
Patient-centered care (PCC) has been described as a key contributing dimension of quality health care in the 21st century and includes patient preferences, values, and the need for information (Institute of Medicine, 2001). Adult learning theory and PCC using the Patient Engagement (PE) model were the two theoretical frameworks chosen to guide the EBP project, as they provide the underpinnings of discharge teaching and planning for adult patients. According to Malcolm Knowles (1989), most adult learners are autonomous, self-directed and prefer content that they perceive to be valuable and relative to their life situation; therefore, their teachers must actively involve them in the learning process (Lieb, 1991). Applying this theory, teachers must allow the learner to focus on their own learning interests, goals, and experiences. This theory fits with the patient engagement model of patient-centered care (PCC) as described by Pelletier and Stichler (2013). The PE model describes “true” PCC as the process of patient empowerment, engagement, and activation. Patient empowerment provides the patient and family with information, education, and encouragement to be active participants and full partners in all care decisions and activities. Patient activation is described as the patients’ abilities to employ the information received to care for themselves or for the family member(s) to care for the patient as necessary. From these two frameworks, it was anticipated that patient engagement in an interprofessional discharge planning process using individually relevant content would assist patients discharged from the rehabilitation center in being fully activated and ready to care for themselves at home as measured by their perceptions of readiness for discharge. It was also anticipated that the proposed interprofessional discharge process would improve the patients’ satisfaction levels and perceptions of the quality of discharge teaching.
A research of the literature was conducted using search engines such as PubMed, CINAHL, and Google Scholar using search terms such as readiness for discharge, quality, discharge teaching, rehabilitation, and interprofessional/interdisciplinary care. Patients describe lack of inclusion and collaboration in the discharge process, and families question their ability to care for patients at home. Often, there is a shortage of postdischarge resources that can help patients with the transition (Forster, et al., 2004).
With decreasing lengths of stay and patients’ increasing acuities even at discharge, transitions from hospital to home have become more involved. Anthony and Hudson-Barr (2004) suggested that a patient's discharge is often driven by provider and system factors rather than a PCC care model that is structured around patients’ knowledge of their home-going needs. Weiss et al. (2007) found that discharge teaching (amount of content received and the nurses’ skill in delivery of the content) and care coordination were predictive of the patients’ perceptions of readiness for discharge (R2 = .51, p < .001); yet, there are many disconnects between the patient's readiness for discharge and their perceptions of the quality of discharge teaching. Content may be delivered in a rushed, last minute method without careful planning or individualization of content based on the patient's specific learning needs. Patients may not be able to anticipate their own physical and emotional needs before discharge and may not see the need to fully engage as an active participant in their own care while in the hospital leaving them vulnerable and susceptible to injury or deterioration once at home. It was reported in one prospective cohort study (n = 400) that nearly 20% of patients experienced adverse events within the first 30 days after discharge including adverse drug events, nosocomial infections, falls, pressure ulcers, and laboratory abnormalities that lead to severe comorbidities or disabilities (Forster, et al., 2003). Fifty percent of the patients in this study experiencing adverse events used additional healthcare services including readmission to the hospital (24%) or visits to the emergency room (11%). Nearly 6% of the reported adverse events were considered as preventable and related to the quality of discharge teaching and the patient's readiness for discharge.
Patients and family caregivers’ level of health literacy was suggested as an important factor in the discharge process (Maurer, Dardess, Carman, Frazier & Smeeding, 2012). Beyond the patient's individual capacity, it is the responsibility of providers to communicate in ways that are understandable to the patient or family caregiver. Communicating health information can be challenging because providers must share information that includes complicated, multistep content. Patients bring individual learning needs and style preferences, unique language skills, cultural differences, age-related physical and cognitive changes, disabilities, and emotions that can affect listening and learning. Health communication frequently occurs under less than ideal circumstances when providers are rushed or patients are scared, ill, and/or in various levels of pain. When individuals do not understand health information, the consequences not only impact a patient's perceived readiness for discharge, but may also result in poorer health outcomes, dissatisfaction, and medical errors (Maurer et al., 2012).
The Institute of Medicine (2004) reported that nearly half of all American adults have difficulty understanding and acting upon health information. Similarly, the World Health Organization (2001) reported that communications strategies that increase access to information and build the patient's capacity to use the information can improve health literacy, decision making, risk perception, and assessment, and can lead to informed action by individuals.
For a successful discharge, Carroll and Dowling (2007) identified a number of discharge planning elements including: (1) communication, (2) coordination, (3) education, (4) patient participation, and (5) collaboration among healthcare personnel. Weiss et al. (2007) reported that a higher quality of discharge teaching correlated with a more positive perception of discharge readiness. Bull and Roberts (2001) described four stages in complete, safe hospital discharge planning including: (1) assessment of the patient, (2) development of an initial discharge plan, (3) implementation of the plan, and (4) assessment of the transition back to the community and follow-up after discharge. To provide a seamless transition from hospital to home, an assessment of patient's perceptions of their abilities to return home and their active engagement in the discharge process is essential. In addition, the discharge process in an acute rehabilitation setting must be interprofessional and customized to the individual needs of patients.
A number of descriptive studies addressed patient quality of life issues related to healthcare provider perceptions of the discharge planning process or a lack of discharge planning (Bull & Kane, 1996; Evans & Hendricks, 1993; McMurray, Johnson, Wallis, Patterson, & Griffiths, 2007). Several quantitative studies also report adverse events and rehospitalization rates after discharge (Evans & Hendricks, 1993; Jack et al., 2009; Jencks, Williams, & Coleman, 2009); yet, there has been a scarcity of controlled studies on discharge planning effectiveness making the current study important.
Moher, Weinberg, Hanlon, and Runnalls (1992) found statistically significant (p ≤ .05, 95% CI) improvements in patient satisfaction as a result of augmented discharge planning provided by a medical team discharge coordinator to facilitate tasks such as discharge planning, the coordination of tests and procedures, and the collection and collation of patient information. Jack et al. (2009) found that patients who received intensive discharge planning via a patient-centered multidisciplinary approach including medication reconciliation, written patient education, and follow-up phone calls, reported increased preparedness for discharge and lower readmissions rates as compared to a control group.
Although there is a paucity of research on readmission rates with discharged acute rehabilitation patients, Smith, Fields, and Fernandez (2010) reported readmission rates to be 2.9 times higher within 30 days of discharge when providers failed to follow physical therapy recommendations for discharge services. Naylor et al. (1994) studied outcomes of intensive discharge planning and home follow-up by advanced practice nurses and reported readmission rates within 24 weeks postdischarge to be 37.1% for the control group and 20.3% for the intervention group, suggesting that close monitoring patients after discharge is a cost-effective care consideration.
There is little research on discharge planning from the patient's perspective with most research focusing on a provider-driven model. Limited research addresses the identification of individualized patient needs before discharge, patient perceived readiness for discharge, patient satisfaction with the discharge process, or the development of general discharge criteria to facilitate a patient's potential for discharge. Discharge plans need to be customized to the patient needs and preferences, rather than expecting the patient to benefit from a plan that the patient may not or cannot follow. The review of the literature supports Knowles’ adult learning theory (1989) and the Pelletier and Stichler (2013) patient engagement model of PCC indicating the need for a coordinated discharge plan that delivers content relevant to the individual patient and delivered in a method that engages the patient and/or family in the process. This premise was the foundation for the development and testing of the interventional methodology, DePART that is described in the methodology section.
A quantitative survey design was used to measure the effectiveness of the interprofessional discharge planning and teaching process to improve patient and provider outcomes. The project used the Quality of Discharge Teaching (QDTS) and Readiness for Hospital Discharge Scale (RHDS) instruments (Weiss et al., 2007) to measure the patients’ perceptions of readiness for discharge. Findings from the preintervention measurement phase informed the intervention which was to make changes to the interprofessional discharge planning and teaching process that would engage patients more fully. Patients’ perceptions were measured using the QDTS and the RHDS after the intervention was implemented. Patient satisfaction rates before and after the change process were also measured. All postintervention measurements were measured 3 months after the DePART change was implemented.
The change project was conducted in a 40-bed inpatient rehabilitation unit within a nonprofit, regional healthcare delivery system in San Diego, California. The convenience sample included 36 patients pre- and 31 patients postchange intervention who volunteered to participate in the study. Subjects represented a sample of all acute rehabilitation patients or their family member who may have completed the surveys if the patient was unable to do so. In some instances, the patient and family member completed the surveys together. Patients (and/or family members) excluded were: non-English speaking patients; patients with severe cognitive deficits and who did not have family or significant others to complete the study for them as a proxy; minors without parental/legal guardian consent; and patients discharged to a noncommunity setting (anywhere other than to home or an assisted living boarding home). Approval from the study hospital's Institutional Review Board was received before the commencement of the study. All data collection was conducted by the coinvestigators who handed the patients (or their family member) the study surveys within 24 hours of discharge. Press Ganey surveys were mailed to all patients by the organization 30 days after discharge.
The project goal was to improve discharge planning and teaching processes and to enhance patient/family empowerment, engagement, activation, confidence, and safety after discharge using an interprofessional and patient engagement approach that was individualized to each patient. The findings from the presurvey results informed some of the changes incorporated in the new discharge process, the DePART. DePART was developed by an interprofessional team using a Lean Six Sigma tools to accelerate the change process, improve the rehabilitation teams’ awareness of problems with the existing discharge process, and enhance their willingness to change. The Lean Six Sigma approach focused on quality improvement in discharge teaching, reducing variability in discharge planning and teaching among providers, increasing efficiency by focusing people's individual needs, and bringing value to the customer (Chalice, 2005; Meisel, Babb, Marsh, & Schlichting, 2007). Process mapping, a Lean Six Sigma tool, was used to examine relationships between people and processes and to identify and eliminate nonvalue added activities in the existing discharge planning and teaching process. Patient surveys, interviews and staff discussions were used by the DePART project team to improve patient satisfaction and readiness for discharge.
Lean Six Sigma's “customer pull” as contrasted to “push” methods were used to improve efficiency (Chalice, 2005). Customer pull was defined as the patient's perception of need that triggered the discharge teaching, rather than “pushing” the teaching when it might interfere with the patient's perceived readiness or relevancy. Customer pull was designed into the DePART process by providing education based on the patient's need and readiness to learn throughout the hospital stay instead of the final days of the patient's stay supporting the Knowles (1989) adult learning theory and the “just in time” principle of Lean Six Sigma. These methods also supported the adult learning (Knowles, 1989) and the PE (Pelletier & Stichler, 2013) theoretical models described earlier.
DePART included the following improvements: (1) the identification of a discharge date and the primary family caregiver within 1 week of the patients’ admission; (2) a shift in home evaluations from that of a therapist measuring the structural needs of the environment alone to a therapeutic opportunity for patients to practice and trouble-shoot strategies with the therapist in their own home; (3) community outings structured with a patient-centered, goal focus; (4) writing physician orders 48–72 hours before discharge for medications and durable medical equipment to ensure accuracy and safety; (5) predischarge scheduling of physician and outpatient therapy appointments to occur within 1 week after discharge; (6) implementing a patient discharge preparation checklist to ensure patients’ and families engagement in the discharge process and to enhance their knowledge of what to expect after discharge; and (7) nursing following-up with patients 24–48 hours and 14 days after discharge by phone to provide support and resources once the patients returned home and to the community.
Demographic survey data were obtained to describe the sample and to control for confounding variables that may have affect the patients’ transition to home. The Readiness for Hospital Discharge Scale (RHDS) was used to measure patients’ perceptions of readiness for discharge (Weiss & Piacentine, 2006; Weiss et al., 2007). The RHDS—Adult Form is a 23-item instrument with four subscales: Personal Status, Knowledge, Coping Ability, and Expected Support. The RHDS is a self-reported summated rating scale with items scored on an 11-point scale (0–10) with anchor words (e.g., “not at all,” “totally”) to cue the subject to the meaning of the numeric scale. Higher scores indicate greater readiness. Construct validity, using confirmatory factor analysis and contrasted group comparisons, and predictive validity have been established for the scale. The Cronbach's alpha reliability coefficient for the total RHDS—Adult Form scale (items 2–23) was reported to be .93 (Weiss & Piacentine, 2006; Weiss et al., 2007; Weiss & Lokken, 2009).
The QDTS was used to measure the patients’ perceptions of the quality of the educational preparation for discharge (Weiss & Piacentine, 2006; Weiss et al., 2007; Weiss, et al. 2008; Maloney & Weiss, 2008; Weiss & Lokken, 2009). Discharge teaching was defined as the composite of all teaching received by the patient during the hospitalization in preparation for discharge home.
The QDTS consists of 18 items with scaling format similar to the RHDS. The six-item “content” subscale measures the amount of content received during discharge teaching. The 12-item “delivery” subscale reflects the skill of the rehabilitation interprofessional team as educators in presenting discharge teaching. The QDTS was modified with the author's permission from the original survey used with adult patients to be more specific for acute rehabilitation patients. Examples of wording changes are outlined in Table 1.
|Item Number||Original||Modifications for Rehabilitation QDTS|
|Direction set||The following words were added: Please complete the form within 0–24 hours prior to discharge from the Rehab unit.|
|3a||How much information did you need from your nurses about your medical needs or treatments (for example, caring for a surgical incision, respiratory treatments, exercise, rehabilitation, or taking mediations in the correct amounts and at the correct times) after you go home?||How much information did you need from your nurses and therapists about your medical needs or therapies (for example, bowel and bladder care, skin care, home exercise program, or taking mediations in the correct amounts and at the correct times) after you go home?|
|3b||How much information did you receive from your nurses about your medical needs or treatments after you go home?||How much information did you receive from your nurses and therapists about your medical needs or therapies after you go home?|
|8||How much did your nurses listen to your concerns?||How much did your team listen to your concerns?|
The “delivery” subscale includes items about listening to and answering specific questions and concerns, expressing sensitivity to personal beliefs and values, teaching in a way that the patient could understand and at times that were good for patients, providing consistent information, promoting confidence in ability to care for themselves and knowing what to do in an emergency, and decreasing anxiety about going home.
The total scale score was calculated by adding the content received and the delivery subscale scores. For the adult sample, the Cronbach's alpha reliability coefficients for the total scale was .92 and for the content received and delivery subscales were reported to be .85 and .93, respectively (Weiss & Piacentine, 2006; Weiss et al., 2007; Weiss, et al., 2008; Maloney & Weiss, 2008; Weiss & Lokken, 2009).
Evaluation of the intervention was evaluated with the Press Ganey Patient Satisfaction rates and the QDTS and RHDS.
Both preintervention and postintervention subjects completed the survey instruments at 0 to 24 hours before discharge from the unit to a community setting (home or assisted boarding home). Data were analyzed using nonparametric statistics and parametric statistics using SPSS v21.0. The significance level was set at alpha = 0.05. The descriptives for the pre- and postintervention samples are outlined in Table 2. Scale reliabilities for the study instruments using this sample and study design were consistent with those reported in previous studies and are outlined in Table 3.
|Pre (n = 36)||Post (n = 31)|
|Age (Mean)||55.17 (17.85)||53.03 (14.42)|
|Gender (%)||Female (44.4)||Female (46.7)|
|Male (55.6)||Male (53.3)|
|Ethnic Group (%)||Hispanic (10.8)||Hispanic (29.0)|
|Black 5.4||Black 6.5|
|White 62.2||White 61.3|
|Asian/Pacific Islander 16.2||Asian/Pacific Islander 3.2|
|Multi-Ethnic 5.4||Multi-Ethnic 0|
|Diagnosis (%)||Spinal Cord Injury (13.9)||Spinal Cord Injury (25.8)|
|Stroke 33.3||Stroke 29.0|
|Traumatic Brain Injury 2.8||Traumatic Brain Injury 19.4|
|Cardiac/LVAD 8.3||Cardiac/LVAD 9.7|
|Orthopedic Disorder 13.9||Orthopedic Disorder 3.2|
|Other 27.8||Other 12.9|
|Education (%)||Kindergarten – 12th grade (37.8)||Kindergarten – 12th grade (30.0)|
|Associate degree 18.9||Associate degree 13.3|
|BA/BS 18.9||BA/BS 33.3|
|MA/MS 10.8||MA/MS 13.3|
|PhD 10.8||PhD 3.3|
|Other 2.7||Other 6.7|
|Number of Items||Previously Published Cronbach's a Using Medical-Surgical Samples (Weiss & Lokken, 2009)||Response Set||Pre (n = 36) Cronbach a||Post (n = 31) Cronbach a|
|Total RHDS scale||22||.93||0–10||.93||.87|
|Personal status subscale||7||.82||.79||.79|
|Coping ability subscale||3||.85||.89||.89|
|Expected support subscale||4||.86||.84||.70|
|Content needed subscale||6||.85||.90||.89|
|Content received subscale||6||.85||.88||.81|
|Press Ganey survey||48||Proprietary||1–5|
|Standard overall patient satisfaction score||48|
|Standard overall top box “Very Good” score||48|
No significant differences were noted between pre- and postintervention patient groups in terms of subjects’ age in years (pre M = 55.17, SD = 17.85 and post M = 53.03, SD = 14.42), gender, ethnic group, or rehab diagnosis. Although the differences were not significant, there was a greater percentage of patients in the postgroup with traumatic brain injury (19.4%) as compared with the pregroup (2.8%), and a larger percentage of patients educated at the baccalaureate level in the postgroup (33.3%) as compared to the pregroup (18.9%). Perhaps statistical significance would have been reached for these categorical data if the sample size in the pre- and postintervention groups would have been larger. There were more doctorate prepared patients in the pregroup (10.8%) as compared to the postgroup (3.3%).
The Press Ganey (PG) Patient Satisfaction scores were compared pre- and postintervention comparing calendar year (CY) mean scores for CY 2010 as compared to CY 2012. There was a statistically significant improvement (p < .01) in the percentage of “very good” scores for overall patient satisfaction (63.5–78.4%) and overall mean score for the PG composite. Significant mean score improvements (p < .05) were also demonstrated in two of the eight discharge-related PG questions – “staff prepared the patient to function in the community” and “nurses instruction on home care and medications.”
Table 4 outlines the mean scores for the pre- and postintervention groups on the RHDS, QDTS, and PG surveys. Using an independent t test measuring differences between pre- and postintervention means on the RHDS, there were no significant differences noted for the total scale score for the RHDS or any of the subscales (Personal Satisfaction Subscale, Knowledge Subscale, or Coping Ability Subscale) except for the Expected Support Subscale (pre M = 8.59, SD = 1.53 and post M = 9.24, SD = .94, p = .038).
|Pre (n = 36)||Post (n = 31)||Significance|
|Pre Mean||Pre SD||Post Mean||Post SD|
|Total RHDS scale||7.75||1.46||7.98||.94|
|Personal status subscale||6.76||1.32||6.78||1.39|
|Coping ability subscale||7.84||1.83||8.14||1.50|
|Expected support subscale||8.59||1.53||9.24||.94||p = .038|
|Total QDTS||7.96||1.43||8.80||1.14||p = .01|
|Content needed subscale||5.64||2.31||6.70||2.50|
|Content received subscale||7.34||1.84||8.10||1.89|
|Delivery subscale||8.28||1.40||9.14||1.11||p = .008|
|Press Ganey survey|
|Standard overall patient satisfaction score||84.3||92.1||p < .05|
|Standard overall top box “Very Good” score||63.5%||78.4%||p < .01|
Using an independent t test measuring differences between pre- and postintervention means on the QDTS, there were significant differences (p = .01) between the pre- (M = 7.96, SD = 1.43) as compared to the postintervention (M = 8.80, SD = 1.14) on the total scale score for the QDTS. No significant differences were noted on the subscales for the QDTS (Content Needed and Content Received subscales). There was a significant difference (p = .008) on the Delivery Subscale (pre M = 8.28, SD = 1.40 and post M = 9.14, SD = 1.11). It should be noted that there were significant differences in both pre- and postdata for the following items comparing pre- and postmeans: (1) “information needed from your nurses and therapists about taking care of yourself” (M = 6.00, SD = 2.708, p = .026) as compared to postintervention (M = 7.52, SD = 2.631); (2) “information needed from your team about your emotions after you go home” (pre M = 4.26, SD = 3.068 and post M = 5.90, SD = 3.166, p = .041); (3) “information needed from your nurses and therapists about your medical needs or treatments” (pre M = 5.74, SD = 2.842 and post M = 7.32, SD = 2.856, p = .028); and (4) “information received from your nurses and therapists about your medical needs and treatments” (pre M = 7.15, SD = 2.341 and post M = 8.84, SD = 1.809, p = .002).
Six items on the QDTS asked questions as to what the patients “needed” as compared to “received” for information to care for themselves, manage emotions, manage medical needs, treatments, or medications, and when and who to call if problems arose after discharge. A paired t test was conducted on these six items of QDTS to determine differences between the questions of “needed” and “received.” Nearly all of the differences between “needed” and “received” items were statistically significant for both pre- and postintervention groups with the exception of postcomparisons of “information needed and received from your team about your emotions after you go home” and “information needed and received about who and when to call if you have problems after you go home.” These items were both significantly different in the preintervention group which can be interpreted that patients perceived a difference in what they needed as compared to what they received. On the postintervention group, there were no significant differences on these items in what patients needed as compared to received, indicating that the DePART intervention positively influenced these items for “managing emotions” and “who and when to call if there were problems” postdischarge.
The significant differences noted on the RHDS subscales for “expected support” (p = .038), the total QDTS (p = .01), and “delivery” subscale (p = .008), and the significant improvements noted on the Press Ganey survey support Knowles (1989) adult learning theory and Pelletier and Stichler (2013) PE model of PCC. When the DePART process was used with rehabilitation patients empowering and engaging them in the discharge planning and teaching process, significant improvements resulted in their perceptions of the quality of discharge teaching and their overall satisfaction.
This EBP change project is unique as there were no other studies noted in the literature using the QDTS or RHDS instruments in the rehabilitation inpatient setting to test changes in patient satisfaction scores, patients’ readiness for discharge, or their perceptions of the quality of discharge teaching. DePART initiated early, after admission, positively influenced the patients’ perceptions of overall quality of the discharge teaching, the delivery of the discharge teaching, and patient satisfaction levels. It should be noted that significant differences between what the patients perceived they needed as compared to what they received in discharge teaching should be monitored on a regular schedule to ensure that patients’ perceived needs are met. The findings in this EBP project are validated by other previously published studies that report positive effects of discharge planning and teaching on patient outcomes (Weiss et al., 2007, 2008).
Several limitations of the study should be noted. The small convenience sample and single site limit the generalizability of the study. The EBP change project was meant specifically for the project site, but the findings may be used by other rehabilitation hospitals as a best practice example or as a foundation for future research studies. It is unknown how other instruments that measure patient readiness for discharge or the quality of patient discharge teaching might have affected the findings reported in this project as compared to the selected instruments. It is also unknown how other planned interventions might have affected the project's findings. It is likely that the organization's focus on improving patient satisfaction levels with improvements in discharge planning and teaching may have also influenced the department's culture and may have contributed to the outcomes as much as the actual intervention.
The findings of this EBP change project have strong application to practice. A PCC approach that uses adult learning theory and empowers, engages, and activates the patient in their individualized plan for discharge is recommended for inpatient rehabilitation and postdischarge home settings. The DePART was an effective method of improving patient satisfaction scores, patients’ readiness for discharge, and the perceived quality of discharge. Replication of the EBP project is recommended in other inpatient rehabilitation units as a best practice example or the foundation for future research.