Crowd Science: Magnet® Hospitals Collaborate to Define Discharge Models of Care

Purpose: The American Nurses Credentialing Center (ANCC) commissioned an innovative pay-to-participate multisite study focused on preventing hospital readmissions. More than thirty Magnet hospitals joined the study with an anticipated 25,000 patients to be recruited. An increasing amount of scientific research is done in an open collaborative method and sometimes referred to “crowd science”. Large scale studies in Magnet Hospitals leverage the power of Magnet Hospitals to engage in research on topics of importance to nursing practice, engage clinical nurses in research about their practice, and create learning opportunities about nursing research in clinical practice settings. The Readiness Evaluation and Discharge Interventions (READI) study is focused on discharge preparation as a primary function of hospital-based nursing.  The first phase of the READI study was to assess the standard of care discharge model in participating hospitals.

 Methods: Phase one of the READI study included a discharge model of care survey sent to participating Magnet hospitals to explore the model for discharge preparation in use at each site. The purpose of the survey was to: (1) Describe how Magnet hospitals are operationalizing discharge preparation processes and (2) Provide information on discharge practices to build context variables for the READI study.  Thirty-two Magnet hospitals participating in the READI study completed a Web-based survey with each hospital reporting on two units (implementation and control). Descriptive analysis was completed with grouping by unit type and hospital size for some sections of the analysis.

 Results: General findings include: (1). Each hospital operationalized  their discharge model of care differently; (2) Many hospitals are participating in national discharge initiatives and customizing aspects of these models into their unique discharge models of care; (3)Unit-based registered nurse (RN) Case managers are being used extensively for discharge planning; and (4) Clinical RNs are the primary discharge teachers. Specific results describing discharge preparation components (discharge coordination, discharge teaching, discharge planning) will be discussed.

 Conclusion: No one approach to discharge preparation or discharge model of care is completely successful in preventing readmissions. The role of the clinical nurse, the primary discharge teacher, is understudied.  The READI study focuses on the clinical nurse’s contribution to discharge readiness. Research implementation in multiple hospitals requires intense coordination to maintain intervention fidelity. The READI study uses an adaptation of the Conceptual Model for Considering the Determinants of Diffusion, Dissemination, and Implementation of Innovations in Health Services Delivery and Organizations as an overall framework to guide the study. Key components of the adapted framework will be shared.