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SINI 2024: A Quality Improvement Initiative of Psychiatric Inpatient Satisfaction Scores Related to Discharge with Education and Use of a S.M.A.R.T. Discharge Planning Protocol

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Chen, Yeyin
Roberson, Anthony James
Brown, Mary-Michael
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2024-07-18
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Background: The Mental Healthcare Act (MHCA) from 2017 requires hospitals to use discharge planning to prevent adverse patient events such as medication errors and inadequate follow-up resulting from poor communication in discharge instructions. However, the inconsistency in the quality of discharge instruction has been identified as a significant issue that may have negative consequences for patients after they are discharged from psychiatric inpatient units. A 2021 study by Smith et al., found that patients leaving psychiatric inpatient units without proper discharge planning faced higher risks, including hospital readmission, emergency visits, homelessness, incidents of violence, encounters with law enforcement, and increased mortality rates. In this study of more than 18,000 patients, 54% did not receive comprehensive discharge planning, with more than 20% missing scheduled follow-up care. Objective: This QI project determines whether implementing the Anne Arundel Medical Center (AAMC) SMART discharge protocol for evidence-based discharge planning positively influences patient satisfaction scores in a Psychiatric Inpatient Unit, focusing on three discharge-related questions. Methods: This QI project will be divided into two phases, including two weeks of pre-implementation and 12 post-implementation weeks. This quality improvement initiative starts by analyzing the baseline data of patient satisfaction scores related to three discharge questions from 10/1/2023 to 10/31/2023. It will then proceed to measure the same outcome over the following three months after implementing the AAMC SMART Discharge Protocol for patients admitted to McNew psychiatric inpatient unit. The SMART discharge planning includes five critical pieces of information: Symptoms, Medications, Appointments, Results and Talk (questions and concerns). All nurses in the psychiatric inpatient unit will receive education by completing the SMART discharge protocol learning package and quizzes during the pre-implementation phase and attending one in-person group training sessions by November 30th, 2023. Every nurse will complete the SMART Discharge Protocol Quiz after receiving SMART discharge protocol education and one month after the training, both one month and three months into the program. Results: The results of this quality improvement project will determine whether patient satisfaction scores related to three discharge questions in Press Ganey's Inpatient Behavioral Health Survey improved after implementation of AAMC SMART discharge protocol a psychiatric inpatient unit. Conclusions: This project will provide a user-friendly discharge planning format to enhance patient education and improve patient satisfaction. It is essential to provide standardized and consistent communication to improve patients’ understanding and compliance with discharge instructions regarding their symptoms, medication, appointments, results, and potential questions.

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Poster with abstract presented at the University of Maryland School of Nursing, Summer Institute in Nursing Informatics (SINI) 2024: Health Care Informatics IQ: Fostering the Human Connection.
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