The impact on quality of services of the introduction of a nurse led admission and nurse led discharge process in a surgical day ward

The study investigated how the introduction of nurse led admission and discharge processes could impact on the quality of service delivered in a surgical day ward. The study used an adapted qualitative outcome analysis (QOA) methodology developed by Morse, Penrod and Hupcy (2000). This complex methodology has 2 phases and 7 steps. Phase 1 included an assessment of the current service using a SWOT analysis, a process mapping exercise and a retrospective documentation evaluation.

Phase 2 involved implementing changes in nursing practice and associated processes based on the outcomes from the phase 1 results. Nurse led admission and discharge processes were implemented as part of a QOA project in phase 2. This was supported by multidisciplinary developed policies and protocols. In service training and education were provided to the nursing and medical staff in advance of the project implementation. Staggered admission times for local and conscious sedation patients were also introduced in an attempt to reduce pre-operative wait times. The service was re-assessed for the impact of these initiatives using repeat process mapping and repeat documentation evaluation which included measurement of the number of patients admitted and discharged by nursing staff.

The results of the study showed the success of the introduction of nurse led discharge (30/38 patients) with associated medical time savings of 2hrs and 40m. It confirmed that the standard of nursing documentation is comprehensive and consistent compared to medical documentation and this has further improved with the introduction of new nursing admission and discharge care plans. An associated link was also identified with staggered admission times and a reduction in pre-operative wait times. Finally, the QOA project laid the foundations for long term practice changes in the day ward which is supported by multidisciplinary developed policies and discharge criteria supported by best practice guidelines.