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Implementation of a Daily Goals Checklist Utilizing Care Pathways into Interdisciplinary Rounds

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2025-05
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Problem: The Vascular Surgery Progressive Care Unit at a large urban hospital has an average 4-hour discharge time, with only 8.7% of patients being discharged by noon, falling short of its 20% discharge by noon and 3-hour discharge time goals for fiscal year 2024. Longer discharge time impacts patient satisfaction, costs, and limits bed availability. Multidisciplinary care pathways in place improved recovery and discharge, with potential to enhance nurse communication through better integration. Purpose: The purpose of this quality improvement project is to implement a practice change to improve communication during daily interdisciplinary rounds (IDR) and adherence to evidence-based clinical pathways through the use of structured Daily Goals Checklist (DGC) tools, to enhance discharge time, increase discharges by noon, and further shorten the length of stay. Methods: The DGC tool from the Agency for Healthcare Research and Quality was adapted to meet the unit specific needs and implemented during a 15-week period in the Fall of 2024. Nurses selected the appropriate DGC pathways for nine vascular surgeries and a non-pathway for other patients completing a tool for each during the IDR for adults over eighteen admitted to this unit. The project lead performed weekly audits of completed tools and retrospective chart analysis. Huddles, snacks, and daily secure text reminders were utilized for adherence. Results: There was an adherence rate of 59.2% and an average discharge time of 4.9 hours, with 14.6% of discharges done by noon if ordered by 9 am. The average length of stay remained seven days. Conclusions: Using evidence- based care pathways in the DGC tool during IDR can improve the discharges by noon, and serve as a proactive measure for nurses to advocate for enhanced patient care and discharge readiness during IDR and shift change handoffs. Future embedment into the electronic health record will improve sustainability.

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