The effectiveness of protocol drive, nurse-initiated discharge in a 23-h post surgical ward: A randomized controlled trial

BackgroundA 23-h unit was established in June 2005 to relieve pressure on surgical beds. Patients were to be discharged by 0900 h without review by a doctor. However, discharge without review remained the exception rather than the rule.ObjectiveThe aim of the current trial was to asses the affect of a protocol driven, nurse-initiated discharge process on discharge time, patient satisfaction and adverse events.DesignRandomised controlled trial.SettingA large, major metropolitan hospital in Queensland, Australia.ParticipantsPatients undergoing a surgical procedure and requiring an overnight stay in the 23-h unit were eligible for inclusion. 182 were randomised and 131 patients completed the study.MethodsParticipants were randomly assigned into one of two groups: protocol driven, nurse-initiated or usual care. The primary end-point was the proportion of patients discharged by 0900 h. Patients completed a self-report questionnaire two weeks after hospital discharge, to evaluate their satisfaction.ResultsOf the 131 patients completing the trial, only 82 (62.6%) were discharged by 0900 h. In the Protocol group 45 (78.9%) patients were discharged on time compared with 37 (50.0%) in the usual care group. This difference was statistically significant (OR 3.75; 95% CI-1.74–8.21; p = 0.001). The average length of stay in the 23-h unit was 16.5 (SD 6.8) h. This did not differ by group (MD 0.29; 95% CI-2.13–2.71; p = 0.81). The overall mean satisfaction score was 95.4 (SD 8.8) and results were similar between groups (Protocol group 96.2 versus usual care group 94.6; p = 0.40).ConclusionsA protocol driven, nurse-initiated discharge process in an overnight post surgery unit results in a higher proportion of patients being discharged by 0900 h without compromising patient satisfaction.