August 3, 2017

Patient Flow Nurses help increase efficiency of discharge process

Patient Flow Nurses (PFNs) are passionate about their role — helping expedite the discharge of patients to decrease length of stay, reduce readmissions and open beds for other patients.

Patient Flow Nurses meet monthly to discuss methods to improve patient discharges, improving access to beds for new patients as well as improving patient and provider satisfaction. (photo by Joe Howell)

Patient Flow Nurses (PFNs) are passionate about their role — helping expedite the discharge of patients to decrease length of stay, reduce readmissions and open beds for other patients.

The PFN program became fully operational in February 2016, and there are now about 30 patient flow nurses in 21 units. The job isn’t a position; it’s a role on the unit in addition to other responsibilities.

“It’s one consistent role that does discharges and they do it safely, appropriately and efficiently,” said Joanie Jeannette, MSN, R.N., administrative director of the Medicine Patient Care Center. “I can’t say enough about them. I think that they are just a very unique group of nurses who work well together and have a lot of ideas and collaborate.”

With patient flow nurses, staff on units have a point person to contact with discharge issues. The nurses initiate the discharging of patients either following morning rounds with the team or based on “anticipated discharge” orders that are entered by physicians the afternoon before. They work with multiple entities to find and surmount the barriers to discharge of a patient. It may be working to order a lab test or making sure a prescription is filled. Or it may be as simple as tracking down the appropriate physician for a discharge order.

As a result, some patients are released hours earlier, resulting in increased patient satisfaction. Patients are never discharged until they are medically ready and when the patient is ready. Patient flow nurses give discharge information to patients in a concise manner.

“The PFN role was implemented to help decrease the length of stay of our patients by increasing the number of daily discharges and a goal of discharging patients before 11 a.m. and out of the system within two hours of a discharge order being placed, said Olivia Mays, R.N., a Patient Flow Nurse at Vanderbilt University Adult Hospital. “We hope to achieve this all while ensuring efficient education and safe/appropriate discharges.”

PFNs have been getting results. Since the program was implemented, discharges went from 784 per week to an all-time high of 843 per week as of May 2017. The average length of stay has decreased from 4.94 days to 4.74 days and 30-day readmission rates have also decreased.

Aligning to the Medical Center’s Strategic Compass, the Patient Flow Nurses program represents Design for Patients and Families.

PFNs also improve overall nurse satisfaction, Jeannette said. While PFNs are working on discharges, other nurses can focus on more acute patients, Jeannette said.

“Ultimately, the patients are placed where they need to go, whether that be home or a subacute facility,” she said. “Patients who need beds can be admitted more quickly.”

Patient Flow Nurses are never finished in their quest to improve patient flow. They meet at least monthly to share best practices and work to standardize admission and discharge packets to further reduce length of stay.

“I love being the PFN because of the relationships I have built with other members of the team, not just the nurses,” Mays said. “I also feel I have expanded my knowledge and have a better understanding of the entire discharge and institution flow by being able to work with so many other roles throughout the hospital.”