A Quality Improvement Approach to Discharge Planning Services in NTUH Urology Ward

16 Aug 2025 14:15 14:30
Piao-Yi ChiouTaiwan Speaker A Quality Improvement Approach to Discharge Planning Services in NTUH Urology WardBackground: Unplanned hospital readmissions are associated with increased morbidity and mortality, particularly among older adults. Although structured discharge planning and follow-up may reduce readmissions and improve post-discharge outcomes, more evidence is needed to confirm their effectiveness in high-risk populations. Objectives: This quality improvement project aimed to (1) reduce 30-day unplanned readmissions, (2) enhance discharge readiness through structured education, and (3) improve patient and caregiver satisfaction with discharge planning and transitional care. Methods: A nurse-led, multidisciplinary discharge planning program was implemented in a urology ward of a medical center in Northern Taiwan. High-risk patients were identified based on impaired function, medical tubing, unhealed wounds, recent transplantation, or chemotherapy. Interventions included nurse training, tailored patient education, caregiver coaching, follow-up calls within one week of discharge, and referrals to home or long-term care services. Results: In 2023, 1,042 high-risk patients were enrolled, with 99.4% completing follow-up. Sixteen cases (1.5%) involved unplanned readmissions or emergency visits, down from 19 cases (1.7%) in 2022. Common concerns included wound care, catheter issues, and symptom management. Patient satisfaction with nursing and medical care averaged 4.9/5, and family satisfaction remained high (4.7/5). Thirteen patients were referred for further care. Internal audits showed improved nurse compliance with risk screening and documentation. Conclusion: This structured, nurse-led discharge program effectively reduced readmissions and improved satisfaction among high-risk urological patients. Findings support the value of individualized, patient-centered transitional care. Digital tools may enhance future outcomes.