Sample Answer for NUR 630 Topic 4 DQ 2 Included After Question

You are the nurse leader on an obstetrics unit. You have been tasked to utilize a Six Sigma approach for standardizing the discharge process. Where do you start?

A Sample Answer For the Assignment: NUR 630 Topic 4 DQ 2

Title: NUR 630 Topic 4 DQ 2

LATRICE

“Six sigma approach is used in healthcare to reduce defects that can result in medical error, improve process efficiency, and eliminate waste.”( Purdue University, 2022) As a nurse leader of an obstetrics unit I would use the six sigma approach for standardizing the discharge process. The six sigma approach uses 5 principles to help improve patient care. The principles include define, measure, analyze, improve, and control. I would first start by assessing the current discharge system. I would define what should included in the discharge process. For example, making sure that patients have received their medication and follow up appointments scheduled before leaving the facility. I would then measure the current system in place by looking at the patients that are being discharged and following up to see what actions was not performed and what actions were omitted. I would then analyze the information found about the discharge process. I would then come up with ways to improve the discharge system. For example, I would create a template to use to help make sure that patients have received everything that they need to continue care at home. I would have checklist that should be performed before discharging patients to ensure that the proper ;process was followed. I would come with ways to improve the discharge system or change the system in its entirety. I would use surveys to obtain information from patients and follow up by addressing the areas identified from the survey. Lastly, I would develop a control system. This system would include having the pharmacist sign discharge instructions regarding the medication, the provider signing the discharge instructions stating that they explained the discharge to the patient and made sure that they understood and comprehended. The nurse would be responsible for providing patient education teachings before discharge. All entities would be required to sign off on the discharge template. In general the basics of discharge plan should include, “evaluation of the patient by qualified personnel, discussion with the patient and or their representative and involving them in the planning, Reconciling medications, planning, for the homecoming or transfer to another care facility, determine the need for caregiver training or any other support, and referrals to a home care agency and or appropriate support organizations in the community, arranging for follow-up appointments or tests, and who to contact if you need help.” (Levine, 2022)

Advance in Healthcare with Lean Six Sigma. (2022). Purdue University. http://purdue.edu

Levine, C. (2022). Hospital Discharge Planning: A Guide for Families and Caregivers. http://caregiver.org

Response

Hello Latrice! Thank you for sharing. Your post is detailed and interesting to read. Discharge process in obstetrics unit is challenging for many organizations. The discharge process is often tedious and inefficient and patients are forced to spend considerable time to complete all the required discharge procedures (Cadel et al., 2021). As a result, delays in discharge process cause adverse events such as frustrations and dissatisfaction among the patients and their families. As such, the Six Sigma approach is a critical tool in addressing the challenges with discharge process such as delays. The approach entails scientific principle that helps in estimating all activities in health care setting using various statistical tools (Molla et al., 2018). It is characterizes a set of tools and a way of comprehending how to evaluate and study clinical operations more effectively to realize better results for health care givers, patients, and health care delivery systems (Arafeh et al., 2018). Successful implementation of the Sigma approach is crucial in increasing quality of care, patient satisfaction, and accessibility of beds for admissions in obstetrics unit.

References

Arafeh, M., Barghash, M. A., Haddad, N., Musharbash, N., Nashawati, D., Al-Bashir, A., & Assaf, F. (2018). Using six sigma DMAIC methodology and discrete event simulation to reduce patient discharge time in king hussein cancer center. Journal of healthcare engineering, 2018. https://www.hindawi.com/journals/jhe/2018/3832151/

Cadel, L., Guilcher, S. J., Kokorelias, K. M., Sutherland, J., Glasby, J., Kiran, T., & Kuluski, K. (2021). Initiatives for improving delayed discharge from a hospital setting: a scoping review. BMJ open, 11(2), e044291. http://dx.doi.org/10.1136/bmjopen-2020-044291

Molla, M., Warren, D. S., Stewart, S. L., Stocking, J., Johl, H., & Sinigayan, V. (2018). A Lean Six Sigma quality improvement project improves timeliness of discharge from the hospital. The Joint Commission Journal on Quality and Patient Safety, 44(7), 401-412. https://doi.org/10.1016/j.jcjq.2018.02.006

DEANNA

As a manager of a Labor and Delivery unit the discharge process is very tedious as a nurse is attempting to teach a very tired mother about the care of her infant and herself. Most postpartum patients are not in an efficient learning mode at time of discharge and many teaching methods are necessary. As with any nursing unit efficiency is necessary to maintain productivity and efficiency. In the developing a discharge process it is necessary it is to be successful yet efficient. A key market used I improve discharge process form hospital settings is to decrease variations through preplanning discharges and use of workflow checklists (Rollinson et al., 2021). 

The Six Sigma process is a Lean strategy that focused on decreasing variation and has been used in multiple heath care settings to decrease waste. The Key concepts of Six Sigma are the DMAIC Or DMADV tools, these methods are translated into measurable responses to reduce variables and streamline (Fondahn et al., 2016)     

Using the DMADV process in implementing the discharge process, first you would Define the issue needing to be addressed. Set Measurements of the process such as decreased teaching time. Analysis of the data is required to set the design of the process, analysis of areas that gap development or identifying old systems. Design the process is the meat of the process to educate the nurses in a systematic fashion. Finally, to verify the process is effective, and them to continually address the process to ensure it is effective and adjust as necessary.  In any QI project following a set tool to address the identified problem will make the process go smother. 

Fondahn, E., Lane, M., &Vannucci, A. (2016). The Washington manual of patient safety and quality improvement [e-book]. Wolters Kluwer .

Rollinson, T., Furnival, J., Goldberg, S., & Choudhury, A. (2021). Learning from lean: A quality improvement project using a lean-based improvement approach to improve discharge for patients with frailty in an acute care hospital. BMJ Open Quality, 10(4), e001393. https://doi.org/10.1136/bmjoq-2021-001393

Response

Hello Deanna! Thank you for sharing your post. You have given an in-depth and compelling post about the application of the Six Sigma approach to improve discharge process in the obstetrics unit. Indeed, discharge process is challenging. However, the Six Sigma approach is a vital change management tool to enhance discharge time (Improta et al., 2020). According to Arafeh et al., (2018), when using the concept of Six Sigma DMAIC process, the initial step is to define the issue through recognition of the essence of standardizing the process of discharge to reduce the whole turnaround time used on each patient in the unit. The next step is to measure the issue by judging the existing process and gathering data by breaking down the work composition in the discharge process from the time of approving discharge to time the patient leaves the unit. Consequently, analysis is conducted to identify and eradicate mistakes in all sub-processes in the discharge process. The next step involves improvement where the identified reasons for delays in the process of discharge are recognized and classified on the basis of priority. Finally, control is conducted by promoting programs identified to assist in maintaining the improvements in discharge process.

References

Improta, G., Guizzi, G., Ricciardi, C., Giordano, V., Ponsiglione, A. M., Converso, G., & Triassi, M. (2020). Agile six sigma in healthcare: Case study at santobono pediatric hospital. International journal of environmental research and public health, 17(3), 1052. https://doi.org/10.3390/ijerph17031052

ANGELA

Six Sigma employs a variety of quality tools including DMAIC. DMAIC is a five-step, problem-solving process which includes define, measure, analyze, improve, and control. The DMAIC method is appropriate for improving the discharge process in obstetrics because its goal is to improve existing processes by defining the problem or issue for improvement, measuring the performance of the process by collecting relevant data, analyzing the data to determine the root causes of the issue, improving the process by eradicating the root causes, and controlling improved processes through monitoring to ensure the better results are sustained (Fondahn et al., 2016, p. 81). 

The first step in improving the discharge process is to define the problem; why does the discharge process need improving or what can be done to streamline the process? This is an opportunity for improvement and therefore specific goals and objectives must be established (Ahmed, 2019). The next step is to retrieve and measure data. The information must be clear and concise. Once data has been collected, Ahmed (2019) indicated it must be analyzed using value stream mapping (VSM) to find the cause(s) of the quality issue. Next, the discharge process must be changed or modified once the root cause(s) has been identified and eliminated. The last step is to establish a quality control plan to monitor the improved process performance (Ahmed, 2019). Utilizing the DMAIC method allows organizations to create a clear path to successfully achieve their goals. 

 References 

Ahmed, S. (2019). Integrating DMAIC approach of Lean Six Sigma and theory of constraints toward quality improvement in healthcare. Reviews on Environmental Health, 34(4), 427-434. https://doi.org/10.1515/reveh-2019-0003 

Fondahn, E., Fer, T. M., Lane, M., &Vannucci, A. (2016). Washington manual of patient safety and quality improvement. Lippincott Williams & Wilkins. 

Response

Hello Angela! Thanks for sharing this impressive post. An extensive, disorganized discharge process is a common challenge for health care settings. It causes decrease in patient satisfaction, frustrations, and delays for patients that need admission (Jeffers, 2021). Moreover, the complexity of discharge process entails organization specific issues that restrict generalizability of solutions. The application of the six sigma approach can be a successful tool in enhancing discharge process in obstetrics unit. Six sigma approach characterizes a set of tools and a way of comprehending how to evaluate and study clinical operations more effectively to realize better results for health care givers, patients, and health care delivery systems (Improta et al., 2020). The primary objective of the six sigma approach is the utilization of measurement-based techniques that centers on improving processes and reducing variations by implementing improvement projects. This can be realized through the utilization of six sigma sub-methodologies of like DMAIC. DMAIC is ideal in standardizing discharge process in the obstetrics unit because it focuses on improving the available discharge processes that fall below specification, developing discharge processes at six sigma quality levels, and looking for incremental discharge enhancement (Ahmed, 2019).

References

Ahmed, S. (2019). Integrating DMAIC approach of Lean Six Sigma and theory of constraints toward quality improvement in healthcare. Reviews on environmental health, 34(4), 427-434. https://www.degruyter.com/document/doi/10.1515/reveh-2019-0003/html

Jeffers, A. M. (2021). Safe transitions from the hospital to home: A review of the pediatric hospitalist’s discharge workflow. Current problems in pediatric and adolescent health care, 51(5), 101021. https://doi.org/10.1016/j.cppeds.2021.101021

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Topic 4 DQ 2

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Topic 4 DQ 2

Latrice Hatch

Constantine Dapilma

Deanna Higgins

Angela Jackson

Constantine Dapilma

Angela Jackson

Rebecca Luetke

Constantine Dapilma

Katherine Martin

Carolee McPherson

Deanna Higgins

Charles Nderu

Rebecca Luetke

Carin Schmidt

Ramona Chatman

Rebecca Luetke

Ramona Chatman

Jessica Albracht

Jessica Albracht

Ramona Chatman

Tanya Perkins

Magela Rodriguez

Latrice Hatch

Tanya Perkins

Rebecca Luetke

Crystal Young

Crystal Young

Deanna Higgins

Tanya Perkins

Constantine Dapilma

Tanya Perkins

Topic 4 DQ 2

Mar 3-7, 2022

You are the nurse leader on an obstetrics unit. You have been tasked to utilize a Six Sigma approach for standardizing the discharge process. Where do you start?

REPLY TO DISCUSSION

Latrice Hatch

Posted Date

Mar 7, 2022, 11:49 PM

Read

Advance in Healthcare with Lean Six Sigma. (2022). Purdue University. http://purdue.edu

Levine, C. (2022). Hospital Discharge Planning: A Guide for Families and Caregivers. http://caregiver.org

Constantine Dapilma

replied toLatrice Hatch

Mar 9, 2022, 6:53 AM

Replies to Latrice Hatch

Hello Latrice! Thank you for sharing. Your post is detailed and interesting to read. Discharge process in obstetrics unit is challenging for many organizations. The discharge process is often tedious and inefficient and patients are forced to spend considerable time to complete all the required discharge procedures (Cadel et al., 2021). As a result, delays in discharge process cause adverse events such as frustrations and dissatisfaction among the patients and their families. As such, the Six Sigma approach is a critical tool in addressing the challenges with discharge process such as delays. The approach entails scientific principle that helps in estimating all activities in health care setting using various statistical tools (Molla et al., 2018). It is characterizes a set of tools and a way of comprehending how to evaluate and study clinical operations more effectively to realize better results for health care givers, patients, and health care delivery systems (Arafeh et al., 2018). Successful implementation of the Sigma approach is crucial in increasing quality of care, patient satisfaction, and accessibility of beds for admissions in obstetrics unit.

References

Arafeh, M., Barghash, M. A., Haddad, N., Musharbash, N., Nashawati, D., Al-Bashir, A., & Assaf, F. (2018). Using six sigma DMAIC methodology and discrete event simulation to reduce patient discharge time in king hussein cancer center. Journal of healthcare engineering, 2018. https://www.hindawi.com/journals/jhe/2018/3832151/

Cadel, L., Guilcher, S. J., Kokorelias, K. M., Sutherland, J., Glasby, J., Kiran, T., & Kuluski, K. (2021). Initiatives for improving delayed discharge from a hospital setting: a scoping review. BMJ open, 11(2), e044291. http://dx.doi.org/10.1136/bmjopen-2020-044291

Molla, M., Warren, D. S., Stewart, S. L., Stocking, J., Johl, H., & Sinigayan, V. (2018). A Lean Six Sigma quality improvement project improves timeliness of discharge from the hospital. The Joint Commission Journal on Quality and Patient Safety, 44(7), 401-412. https://doi.org/10.1016/j.jcjq.2018.02.006

Deanna Higgins

Posted Date

Mar 7, 2022, 9:50 PM

Read

Fondahn, E., Lane, M., & Vannucci, A. (2016). The Washington manual of patient safety and quality improvement [e-book]. Wolters Kluwer .

Angela Jackson

replied toDeanna Higgins

Mar 8, 2022, 7:23 PM

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Replies to Deanna Higgins

Hi Deanna,  

I agree that the discharge process is critical. Although complex and sometimes lengthy, it is necessary in aiding patients to manage their care at home successfully. Hence, the need to ensure the discharge is comprehensive, timely, and effective. As health care continues to evolve, health care organizations are tasked with improving quality and efficiency and are therefore adopting lean process improvement strategies to accomplish this goal (Nicosia et al., 2018). However, it is important that these strategies are designed to be patient-centered to enhance patient satisfaction and engagement. I believe the lean approach is beneficial in the discharge process and should be widely employed in the health care setting. 

References 

Nicosia, F. M., Park, L. G., Gray, C. P., Yakir, M. J., & Hung, D. Y. (2018). Nurses’ perspectives on lean redesigns to patient flow and inpatient discharge process efficiency. Global Qualitative Nursing Research, 5, 233339361881065. https://doi.org/10.1177/2333393618810658 

Constantine Dapilma

replied toDeanna Higgins

Mar 9, 2022, 6:53 AM

Replies to Deanna Higgins

References

Arafeh, M., Barghash, M. A., Haddad, N., Musharbash, N., Nashawati, D., Al-Bashir, A., & Assaf, F. (2018). Using six sigma DMAIC methodology and discrete event simulation to reduce patient discharge time in king hussein cancer center. Journal of healthcare engineering, 2018. https://www.hindawi.com/journals/jhe/2018/3832151/

Improta, G., Guizzi, G., Ricciardi, C., Giordano, V., Ponsiglione, A. M., Converso, G., & Triassi, M. (2020). Agile six sigma in healthcare: Case study at santobono pediatric hospital. International journal of environmental research and public health, 17(3), 1052. https://doi.org/10.3390/ijerph17031052

Angela Jackson

Posted Date

Mar 7, 2022, 9:37 PM

Read

 References 

Fondahn, E., Fer, T. M., Lane, M., & Vannucci, A. (2016). Washington manual of patient safety and quality improvement. Lippincott Williams & Wilkins. 

Rebecca Luetke

replied toAngela Jackson

Mar 8, 2022, 1:01 PM

Unread

Replies to Angela Jackson

Great Video

Hello Everyone, 

Angela has a great posting. I love that in all of healthcare we are look outside of ourselves, outside of healthcare to find resources to improve care, safety and quality. Lean Six Sigma is a great demonstration of this. Here is a a great video explanation of Lean Six Sigma 

Why is it so important for healthcare to look outside of our profession for ideas for improvement?

Constantine Dapilma

replied toAngela Jackson

Mar 9, 2022, 6:54 AM

Replies to Angela Jackson

References

Ahmed, S. (2019). Integrating DMAIC approach of Lean Six Sigma and theory of constraints toward quality improvement in healthcare. Reviews on environmental health, 34(4), 427-434. https://www.degruyter.com/document/doi/10.1515/reveh-2019-0003/html

Improta, G., Guizzi, G., Ricciardi, C., Giordano, V., Ponsiglione, A. M., Converso, G., & Triassi, M. (2020). Agile six sigma in healthcare: Case study at santobono pediatric hospital. International journal of environmental research and public health, 17(3), 1052. https://doi.org/10.3390/ijerph17031052

Jeffers, A. M. (2021). Safe transitions from the hospital to home: A review of the pediatric hospitalist’s discharge workflow. Current problems in pediatric and adolescent health care, 51(5), 101021. https://doi.org/10.1016/j.cppeds.2021.101021

Katherine Martin

Posted Date

Mar 7, 2022, 7:59 PM

Unread

Six Sigma is a quality improvement (QI) framework that utilizes the “DMAIC” methodology involving five steps: “Define,” “Measure,” “Analyze,” “Improve,” and “Control.” A nurse leader on an obstetrics unit using the Six Sigma approach for standardizing the discharge process would need to start at the “Define” phase. One initial step includes forming a QI team to improve the discharge process (Purdue University, 2021). The team would complete a Project Charter during one of the first team meetings, including the following tasks: naming the problem with the discharge process, defining a goal to improve the discharge process, and assigning team member roles (Purdue University, 2021). 

When naming the problem, it would be essential to look at baseline data and identify national benchmarks. Other initial tasks in the “Define” phase include assessing the voice of the customer (VOC). Surveys could be utilized to evaluate the VOC and completed by nursing staff, physicians, and any other ancillary staff involved in the discharge process. The QI team could utilize complaints and grievances to establish the VOC for the patients since they are also customers in the process. Any data obtained from the surveys should be compiled in a VOC Matrix tool for further trending and assessments by the QI team. 

Another vital tool in the “Define” phase is the Suppliers, Inputs, Process, Outputs, and Customers (SIPOC) diagram (Six Sigma Daily, 2017). The SIPOC diagram is a type of process map completed by the QI team that aids in understanding the steps of the discharge process (Six Sigma Daily, 2017). Determining potential stakeholder barriers is another vital step in the “Define” phase (Purdue University, 2021). Since barriers may exist, it is essential to anticipate them, so the team does not become frustrated if they arise; barriers may be unique and specific to each facility (Molla et al., 2018). The discharge process in an obstetrics unit is cumbersome; however, Six Sigma is an effective tool that could streamline the process and sustain improvement. 

References: 

Molla, M., Warren, D. S., Stewart, S. L., Stocking, J., Johl, H., & Sinigayan, V. (2018). A lean six sigma quality improvement project improves timeliness of discharge from the hospital. The Joint Commission Journal on Quality and Patient Safety, 44(7), 401–412. https://doi.org/10.1016/j.jcjq.2018.02.006

Purdue University. (2021). DMAIC vs. DMADV. Purdue.Edu. https://www.purdue.edu/leansixsigmaonline/blog/dmaic-vs-dmadv/#:~:text=DMAIC%20(Define%E2%80%94Measure%E2%80%94Analyze%E2%80%94Improve%E2%80%94Control),-DMAIC%20is%20the&text=Collect%20data%20from%20the%20process,solutions%20to%20improve%20the%20proces.

Six Sigma Daily. (2017). What is a SIPOC diagram? Sixsigmadaily.Com. https://www.sixsigmadaily.com/what-is-a-sipoc-diagram/

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Carolee McPherson

Posted Date

Mar 7, 2022, 7:48 PM

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Replies to Latrice Hatch

Discharge delays can slow down hospital and emergency department (ED) efficiency. The discharge process is complicated, because it entails posing specific obstacles that limit the answers’ generalizability. The major result when employed over a ten-month period was discharge time. The percentage of patients whose discharge order was made before noon, the percentage of patients leaving the room before noon, hospital length of stay (LOS), and the LOS of admitted ED patients were all secondary end variables. Discharge time was reduced by 22.7 percent, from 2.2 hours before the intervention to 1.7 hours afterward (El-Eid et al., 2019). Although there was no significant change in before noon discharge in the post intervention period, a higher majority of individuals departed their room before noon.

After the intervention, the average length of stay in the hospital was reduced from 3.4 to 3.1 days. In the post-intervention period, the ED means LOS of hospitalized patients was considerably lower (McClay et al., 2020). To optimize discharge time, the Six Sigma technique might be a useful change management tool. Rather of focusing on individual interventions that may be institution-specific, institutions desiring to reduce discharge delays should adopt the essential concepts of Six Sigma.

El-Eid, G. R., Kaddoum, R., Tamim, H., & Hitti, E. A. (2019). Improving hospital discharge time. Medicine, 94(12), e633. https://doi.org/10.1097/md.0000000000000633

McClay, M. A., Swanson, K., & Yuan, C. (2020). Improving the hospital discharge process with six sigma methods. ResearchGate. https://www.researchgate.net/publication/233135958_Improving_the_Hospital_Discharge_Process_with_Six_Sigma_Methods

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Deanna Higgins

replied toCarolee McPherson

Mar 8, 2022, 3:49 PM

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Replies to Carolee McPherson

Hello Carolee,

I could not agree with you more that discharge delays cause slowdowns in hospital throughput in all aspects of the organization. Discharge processes requiring to be streamlined can use the Six sigma tools such as DMADV or DMAIC to help reduce patient teaching time, standardizing discharge times and optimize nursing time (Rollinson et al., 2021). As with any project needing to be streamlined to reduce waste any of the Lean, Six Sigma or 5S tools are excellent QI tools that can be utilized to effectively reduce waste and improve productivity. As you state discharge delays can increase LOS, thus increasing cost exponentially to the hospital. Change is a difficult thing to manage in an organization. The example of discharge process for a specialty unit, and effective tool would be to standardize the process to be the same for every patient, decreasing variations such as time and process with each patient increases wastefulness’ of nursing time (Rollinson et al., 2021). Great identification of a cause effect when a process is streamlined. 

Deanna       

Charles Nderu

Posted Date

Mar 7, 2022, 7:46 PM

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Replies to Latrice Hatch

The sensitivity of the obstetrics unit cannot be overemphasized. The life of the mother and the baby depends on the quality of care that is being offered in this unit. All the process and procedures that are used in the discharge process should be reviewed constantly and improved on whenever any deficiency is found. The six sigma approach being used aims to reduce the time, defects and variability to the minimum. There are two types of six sigma: DMAIC which is used to improve on any system that is in place in the production of goods or services, and DMADV which is used to design a new system from scratch. Since the OB unit already has a discharge process in place, the task that’s at hand is to improve on the discharge process. This means the DMAIC (define, measure, analyze improve and control) process will be used. Defining will involve determining the problems that exist in the discharge process. Measure would involve determining how long it normally takes to do the discharge. Analyze would determine how long the problem affects the discharge process. Improve will involve making changes that will improve on the current discharge process and eliminating the problems that do exist. Control will involve making regular adjustment to the discharge process in order to keep on improving on the discharge process (Robinson et al, 2021).

Reference:

Dempsey, A., Robinson, C., Moffatt, N., Hennessy, T., Bradshaw, A., Teeling, S. P., Ward, M., & McNamara, M. (2021). Lean Six Sigma Redesign of a Process for Healthcare Mandatory Education in Basic Life Support-A Pilot Study. International Journal of Environmental Research and Public Health, 18(21). https://doi.org/10.3390/ijerph182111653

Rebecca Luetke

replied toCharles Nderu

Mar 8, 2022, 12:59 PM

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Replies to Charles Nderu

One of my favorite Six Sigma changes…

Hi Everyone, 

Charles has good insights in answer to this question. When I was a commander of a unit in the Army Nurse Corps we used Six Sigma to try to make positive changes and meaningful streamlining. We used the sticky note method and all gathered and started throwing out ideas on out processes and what could be improved to decrease cost but maintain quality. We realized we were having phlebotomists go into rooms to draw blood while we had nurses and lab techs who were also able to draw blood. The lab techs were generally doing little to no work between 3:30-5 am but staffing the lab. If we had lab techs go and draw the blood and nurses draw in the ICU and ER we could eliminate the phlebotomy position and eliminate a lot of salary/personnel costs when you considered the cost of the hourly wage, the benefits, the workers comp, the malpractice etc. 

Why is streamlining so important in healthcare delivery?

Carin Schmidt

Posted Date

Mar 7, 2022, 7:42 PM

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The discharge process has created and still creates numerous patient safety concerns. Chen et al. (2019) identify that the complex nature and numerous variations have led to issues such as increased cost to the organization and patient, avoidable readmissions, and adverse events. There are many elements that must be accounted for when addressing a change such as the discharge process. Establishing a multi-disciplinary approach to addressing the substantial elements of the discharge process will allow for all aspects of the process to be examined from different perspectives and corrective actions taken.

Six Sigma is a sound and proven quality improvement model to be used to standardize the discharge process in an obstetrics unit. Carlisle & Blanchard (2016) describe Six Sigma as a quality improvement model focused on identifying and eliminating process defects and centered on what the customer values as important. The other aspect of Six Sigma is that it is focused on reducing variation in a particular process – the discharge process in this case (Johnson & Solliceto, 2020). The DMAIC (Define, Measure, Analyze, Improve, and Control) method will provide a guideline to ensure all aspects of the process change are addressed and able to be sustained once the implementation phases are complete. The guiding action of this change must keep the needs of the customer and their safety at the forefront and deliver a quality product that eliminates waste, provides value to the customer, and reduces variation. These elements validate that Six Sigma would be a productive quality improvement model to standardize the discharge process in the obstetric unit.

References

Carlisle, A. & Blanchard, M. (2016). The Washington Manual of Patient Safety and Quality Improvement (E. Fondahn, M. Lane, & A. Vannucci Eds.). Wolters Kluwer.

Chen, N., Xie, X., Zeng, Z., Zhong, X., Brenny-Fitzpatrick, M., Liegel, B. A., Zheng, L., & Li, J. (2019). Improving discharge process at the University of Wisconsin Hospital: A system-theoretic method. IEEE Transactions on Automation Science and Engineering 16(4), 1732–1749. https://doi-org.lopes.idm.oclc.org/10.1109/TASE.2019.2896271

Johnson, J. K. & Sollecito, W. A. (2020). McLaughlin and Kaluzny’s Continuous Quality Improvement in Health Care (5th edition). Jones & Bartlett Learning.

Ramona Chatman

Posted Date

Mar 7, 2022, 7:08 PM

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Replies to Latrice Hatch

Six Sigma, involves improving, designing, and monitoring process to minimize or eliminate waste while optimizing satisfaction and increasing financial stability. The performance of a process—or the process capability—is used to measure improvement by comparing the baseline process capability (before improvement) with the process capability after piloting potential solutions for quality improvement. To begin with a mapping process. The team began would a process map to visually understand how the process was currently working. Each team member would be encourage to have input on the process as it is. Then using the Lean concepts, have the team team revised map – identifying rework loops, non-value-added steps, communication flows and staff movement and adding key metrics utilizing the map process you will be able to see the process the “from-discharge-order-entry-to-patient-leaving’ and “patient leaving-to-discharge-in-computer”

Reference

Al-Zain Y, Al-Fandi L, Arafeh M, Salim S, Al-Quraini S, Al-Yaseen A, Abu Taleb D. Implementing Lean Six Sigma in a Kuwaiti private hospital. Int J Health Care Qual Assur. 2019 Mar 11;32(2):431-446. doi: 10.1108/IJHCQA-04-2018-0099. PMID: 31017052.

Johnson, J. K., & Sollecito, W. A. (2020). Mclaughlin & kaluzny’s continuous quality improvement in health care (5th ed.

Rebecca Luetke

replied toRamona Chatman

Mar 8, 2022, 1:00 PM

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Replies to Ramona Chatman

So many get to share in the decision making process..

Hi Everyone, 

Ramona has some interesting insights in answer to this question. One great aspect many of you have talked about is the aspect of six sigma where a lot of people get to share their opinion. In nursing leadership you will find there is generally greater success with a democratic leadership style and lean six sigma supports that style. When you are making a change, or a process improvement you want to ensure two things as a nurse leader:

1) Your staff has input as they are the ones most impacted (like the staff who will be doing the discharging in this example). 

2) You want to find a way to create buy-in which is easier when the staff has input and is part of the change process. 

How would you solicit input from your entire staff for this change project?

Ramona Chatman

replied toRebecca Luetke

Mar 8, 2022, 4:50 PM

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Replies to Rebecca Luetke

In implemening any model of quality improvement, as the leader you will also need to be the change agent. Change is not an easy thing to influence. People are unsurprisingly opposed to change, and this often makes it difficult for leaders to execute quality improvement within an organization. Nevertheless, change at times is nonexchangeable and essential be applied with or without consciences. Being a change agent requires that one is both imaginative, compelling, and authoritative if need be. One needs to have the fundamental skills and qualities to be an operational change agent. To implement the process improvement, I would utilize John P, Kotter Eight Steps of Change Model.  Change always involves some form of emotions because people enjoy comfort. However, change disrupts this comfort creating a situation filled with anxiety and uncertainty among change recipients. For instance, when change touches on issues close to the hearts of those affected, they will most likely react emotionally due to anxiety or fear of the unknown; Moreover, when change affects the assumptions, values, beliefs, and to a large extent identity of individuals and can make the change recipients reluctant to accept the proposed status. Change leadership is the engine of change, it’s about urgency, vision, empowering people, and seizing opportunity. The goal is to make change happen smarter and faster with an accelerated efficiency. It is the process that fuels large-scale transformation (Kotter & Cohen, 2002)

Kotter, P., Cohen, D. (2002). The Heart of Change. Real-Life Stories of How People Change Their Organizations. e-ISBN 978-1-4221-8733-3

Jessica Albracht

replied toRebecca Luetke

Mar 8, 2022, 5:56 PM

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Replies to Rebecca Luetke

Hi, it is very important to get feedback from the staff, especially when they are at the heart of the process. To get staff involved with feedback for the discharge process I would recommend getting them to elect a person from their group to sit on the committee and voice ideas or even how the new process would work well or not work well. If you have core bedside staff in on the change project it can often help other staff with the buy-in needed for change.

Jessica Albracht

Posted Date

Mar 7, 2022, 12:29 PM

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Replies to Latrice Hatch

Topic 4 DQ 2

The Six Sigma was designed to utilize statistical methods to identify and reduce variations in processes (Johnson & Sollecito, 2020). It can also improve the flow of the department (Johnson & Sollecito, 2020). The use of this particular model would be an excellent choice when standardizing discharges in the obstetrics unit. Slow and inefficient health care processes can impact patient satisfaction scores (Johnson & Sollecito, 2020). This can occur in the discharge process as well. Often when patients hear that they are discharged they can become impatient and ready to leave as soon as possible. Ensuring that this process is standardized across the unit can help get patient home in a timely manner.

The DMAIC (Define, Measure, Analyze, Improve, and Control) would work well with this situation (Fondahn et al., 2016). First the nurse leader would need ot define and measure the issue (Fondahn et al., 2016). This leader would need to look at the current process and identify any issues that need to be corrected. Analyzing the factors that effect the discharge process and placing them into categories of controllable and uncontrollable is also important in oder to identify factors that we can control (Fondahn et al., 2016). This leader would get feedback from staff and patients about to be discharged and look at the evidence-based practice and see if there is a better way to standardize this process. Once these above steps are completed then the leader can begin the implementation process to improve discharge efficiency in a way that is standardized in the entire area. 

References

Fondahn, E., Lane, M., & Vannucci, A. (2016). The Washington Manual of Patient Safety and Quality Improvement. Wolters Kluwer. https://doi.org/ISBN-13: 9781451193558

Johnson, J. K., & Sollecito, W. A. (2020). Mclaughlin & kaluzny’s continuous quality improvement in health care (5th ed.). Jones & Bartlett Learning.

Ramona Chatman

replied toJessica Albracht

Mar 7, 2022, 7:07 PM

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Replies to Jessica Albracht

Understanding, meeting and exceeding patients’ needs and expectations, a healthcare organizations can improve patient outcomes, and at the same time can remain competitive by cutting costs and improving quality. Six Sigma is gives us more opportunities that can be explored. Patients or prospective patients could be used as team members on Six Sigma projects. An outside perspective can also be beneficial in determining what patients want and do not want. For example, some Six Sigma projects may look into minimizing patient length of stay in hospitals after a certain procedure. Most patients want to go home as soon as possible, however some patients might not be able to take care of themselves or might be in too critical of a condition to risk leaving the hospital.

Reference

Tanya Perkins

replied toJessica Albracht

Mar 7, 2022, 7:35 PM

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Replies to Jessica Albracht

Jessica, thank you for such a clear and precise explanation of the Six Sigma Model. I also agree that the use of this model would be an excellent choice when standardizing discharges in the obstetrics unit. I have experienced patient verbalization of their displeasure with a delay from the time the patient is told by the discharging provider they are being discharged. There is nothing as frustrating to patients, family members and staff than slow and inefficient health care processes that can easily affect patient satisfaction scores (Johnson & Sollecito, 2020). Unfortunately, this does occur in the discharge process as well. You are correct that so often when patients hear that they are being discharged they tend to become impatient and ready to leave as soon as possible. Ensuring that this process is standardized across the unit can help get patient home in a timely manner and help to relieve the added stress of an extended hospital stay and anticipation with recovery time at home.  

I also chose to start with the Six Sigma process of DMAIC. The DMAIC approach is used to improve upon current workflows and is broken down to Define the discharge process, Measure the current discharge time from time the discharge order is given until the discharging nurse is instructing the patient concerning her discharge needs, next Analyze any barriers and short falls to timely and patient centered discharge planning, Improve on the discharge processes that have worked in the past on the obstetrics unit and Control the implementation of the changes and improvements identified in the obstetrics unit discharge process. (Niñerola, 2020). Finally, re-evaluation and improve where needed and maintain effectiveness of the changes and implement strategies to support the new unit processes. 

References 

Johnson, J. K., & Sollecito, W. A. (2020). Mclaughlin & kaluzny’s continuous quality improvement in health care (5th ed.). Jones & Bartlett Learning. 

Niñerola, A., Sánchez-Rebull, M.-V., & Hernández-Lara, A.-B. (2020). Quality improvement in healthcare: Six Sigma systematic review. Health Policy, 124(4), 438–445. https://doi-org.lopes.idm.oclc.org/10.1016/j.healthpol.2020.01.002 

Magela Rodriguez

Posted Date

Mar 7, 2022, 9:42 AM

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Replies to Latrice Hatch

A significant number of patients are concerned with the lengthy and inefficient process for inpatient discharge. Utilizing a Six Sigma approach can help standardize the discharge process in the obstetrics unit. The Six Sigma principles will guide the designing of a process improvement framework to address delays in discharge. The Define, Measure, Analyze, Improve, and Control (DMAIC) technique of this approach will help uncover the root cause of this problem. The DMAIC approach will help define the problem, measure the fault/defect, evaluate the reasons, remove major causes to improve the process, and process control to mitigate the recurrence of defects.   

A multidisciplinary team will employ the DMAIC approach to define the scope of problem investigation with a critical focus on improving the administrative process contributing to delays in inpatient discharge. They will map the steps from writing orders to the patient leaving the room (El-Eid et al., 2015). It will help to determine if the process is fragmented. For instance, they may establish that the process is fragmented where providers function in silos and rely on patients to give them alerts to kick off the next step in the discharge process. Once the team establishes a fragmented approach, it will have to perform process redesigning to achieve a single-piece flow that constitutes electronically entered time stamps. The time stamps will apply to each step in the discharge process to reflect the status of the discharge process to all staff (El-Eid et al., 2015). They will also send managers alerts when the delays go beyond the set threshold. It will help to reduce discharge time significantly.

Besides the electronic time stamps, extensive discussions would be necessary to allow the team to complete root cause analysis (RCA) for discharge delays; barriers outlined, waste, and changes proposed from each stakeholder’s perspective (Fondahn et al., 2016). Interventions suggested will be sequentially tested via pilots on selected floors before they are fully implemented across every regular inpatient floor within the facility. This way, adopting Six Sigma core principles will help to improve discharge time within the facility.    

References

El-Eid, G. R., Kaddoum, R. N., Tamin, H., & Hitti, E. A. (2015). Improving Hospital Discharge Time: A Successful Implementation of Six Sigma Methodology. Medicine, 94(12), e633. http://dx.doi.org/10.1097/MD.0000000000000633

Fondahn, E., Fer, T. M. D., Lane, M., & Vannucci, A. (2016). The Washington Manual of Patient Safety and Quality Improvement. Wolters Kluwer Health.

Latrice Hatch

replied toMagela Rodriguez

Mar 8, 2022, 9:37 PM

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Replies to Magela Rodriguez

Hello Magela,

Effective discharge planning should include consists of four different stages, patient assessment, development of a discharge plan, provision of service, and follow-up and evaluation. The four components included assessment of patient’s physiological, psychological, social and cultural needs, care plan development by identifying discharge strategies to patient, career, and community provider, implementation of the plan including information delivered, education provided, and coordination of services. “A structured systematic and coordinated system of hospital discharge process is needed to ensure a smooth patient transition from the hospital to the community and improve patient health outcome in both clinical and social aspect.” ( Yam, Wong, Cheung, et al. 2012). As a nurse we are taught that the discharge process starts immediately after admission. It is important to perform the proper assessments so that you can address all issues and prevent hospital readmission.

Yam,C., Wong, E.L., Cheung, A. et al. (2012). Framework and components for effective discharge planning system: a Delphi methodology. BCM Health Services Res. https://doi.org/10.1186/1472-6963-12-396

Tanya Perkins

Posted Date

Mar 6, 2022, 8:41 PM(edited)

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Replies to Latrice Hatch

Six Sigma is a management system that seeks to improve the efficiency of processes, reducing defects to achieve improved quality and customer satisfaction. Since Motorola implemented it in the mid-1980s, it has become a powerful management tool whose objective is to achieve a quality level of 99.99 %. For this purpose, it uses a stepwise process called DMAIC, whose acronym means Define, Measure, Analyze, Improve and Control. These stages allow improving the quality of any process at the project level or throughout the organization (Niñerola et al., 2020). Most obstetrics unit are required to have an outcome goal of safety, efficiency, privacy and care for the women and infants that the unit serves. These measures should be in place when admitting to the unit, during the stay on unit, and during discharge process. Prior to discharging a patient, the needs of the mother and baby as well as other female patients on the obstetrics unit are thoroughly considered (Samonte & Vallente, 2020).

To begin we will start with the Six Sigma process of DMAIC. The DMAIC approach is used to improve upon current workflows and is broken down to Define the discharge process, Measure the current discharge time from time the discharge order is given until the discharging nurse is instructing the patient concerning her discharge needs, next Analyze any barriers and short falls to timely and patient centered discharge planning, Improve on the discharge processes that have worked in the past on the obstetrics unit and Control the implementation of the changes and improvements identified in the obstetrics unit discharge process. (Niñerola, 2020). Finally, re-evaluation and improve where needed and maintain effectiveness of the changes, and implement strategies to maintain the new unit processes.

References

Samonte, P. R. V., & Vallente, R. U., (2020). Discharge planning. Salem Press Encyclopedia of Health.

Rebecca Luetke

replied toTanya Perkins

Mar 6, 2022, 9:41 PM

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History of Six Sigma

Hello Everyone, 

Tanya has a great post in answer to this question. In healthcare we historically tried to do everything ourselves, we tried to manage the business side and the physical side and the productivity side and the personnel side and we found out that we were trained healthcare providers but not great at the business side. In our realization of how bad we were at business we found amazing resources and guidance and modeling from the world of business. Lean Six Sigma comes from business and manufacturing, it started with Toyota and now is used internationally in all areas of the professional world. 

Below is a timeline of Six Sigma, are you surprised how young Six Sigma is?

Crystal Young

replied toRebecca Luetke

Mar 7, 2022, 6:49 PM

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Replies to Rebecca Luetke

Dr. Luetke,

Thank you for highlighting the age of Six Sigma and bringing it to our attention. Six Sigma comes from a strong line of business management systems attempting to improve production by implementing efficiencies within the workflows. It began with Eli Whitney in 1798; he highlighted the importance of standardization and Henry Ford presented the automatic automobile assembly line. The automatic assembly line improved efficiency and production. In 1987 William Smith perfected the Six Sigma approach by integrating all the components. After Six Sigma was fully adopted quality indicators were developed. In the early 2000’s, healthcare and other various organizations implemented Six Sigma strategies for process improvement. Six Sigma is expanding its reach in the health care systems as it earned much praise for the approach to problem solving (Daly et al., 2021). Within my organization there are new specialty positions for those with a certification in Six Sigma. It is shocking to me that Six Sigma is a relatively new concept for healthcare, but I definitely see its benefits.

Reference

Daly, A., Teeling, S.P., Ward, M., McNamara, M., Robinson, C. (2021). The use of lean six sigma for improving availability of and access to emergency department data to facilitate patient flow.  International Journal of Environmental Research and Public Health, 18(21), 1–15. https://doi.org/10.3390/ijerph 182111030

Crystal Young

Posted Date

Mar 6, 2022, 2:56 PM

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Replies to Latrice Hatch

Six Sigma is a quality model that focuses on efficiencies within the workflows of various organizational settings. Six Sigma integrates safeguard techniques within the workflow to enhance quality and satisfaction. These safeguards are especially critical in the healthcare setting and for standardizing the discharge process (Niñerola, 2020). The obstetrics unit relies heavily on efficient workflows to safely discharge and admit patients. Safety measures should be in place prior to discharging patients from an acute care setting. Patients’ receiving care in the obstetrics unit have mixed acuity levels, so its necessary to know their health conditions and risk factors (Samonte & Vallente, 2020).

To start, using Six Sigma with the DMAIC approach is the best first steps to creating a standard discharge process. The DMAIC approach is used to improve upon current workflows and is broken down to Define, Measure, Analyze, Improve and Control (Niñerola, 2020). In the DMAIC approach, define is the first step which elicits identifying the problems within the workflows for process improvement. The next step is to measure and assess the current discharge workflows that are already in place. After a thorough  assessment of current practices are completed, analysis of the cause of the problem should be identifiable. Once the problem and causes are identified its time to implement practices to improve the process. Finally, control the discharge process, after re-evaluation and proven effectiveness implement strategies to maintain the new workflows (Purdue University, 2022).

References

Niñerola, A., Sánchez-Rebull, M.-V., & Hernández-Lara, A.-B. (2020). Quality improvement in healthcare: Six sigma systematic review. Health Policy, 124(4), 438–445. https://doi.org/10.1016/j.healthpol.2020.01.002

Purdue University. (2022). DMAIC Vs. DMADV. https://www.purdue.edu/leansixsigmaonline/blog/dmaic-vs-dmadv/#:~:text=DMAIC%20(Define%E2%80%94Measure%E2%80%94Analyze%E2%80%94Improve%E2%80%94Control),-DMAIC%20is%20the&text=Collect%20data%20from%20the%20process,solutions%20to%20improve%20the%20process.

Samonte, P. R. V., & Vallente, R. U., (2020). Discharge planning. Salem Press Encyclopedia of Health.

Deanna Higgins

replied toCrystal Young

Mar 6, 2022, 8:13 PM

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Replies to Crystal Young

Hello Crystal,

As a manager of a Labor and delivery unit, a discharge process is cumbersome, and you have to teach parents who are exhausted of how to care for their infant in an efficient manner that is also useful to them. The Six Sigma process is a tool to eliminate defects and reduce variability (Johnson & Sollecito, 2020).  In a discharge process of an obstetrical patient has many variabilities as you state due to acuity and varying cultures, making standardizing the process difficult. The Six Sigma process has the ability to integrate an improvement strategy that strengthens clinical skills in an efficient fashion with the ability to ensure individualization is allowed. The DMAIC method is helpful to creates a consistent process at you stated that follows the same steps ensuring the education is efficient yet enables some movement to meet the needs of the patient. The process in the Six Sigma arena key is in following the steps of the process and remaining consistent to reduce the variables (Johnson & Sollecito, 2020). Great analysis of the process, something I will have to use to streamline our discharge process.

Thanks for the Post

Deanna

Johnson, J. K., & Sollecito, W. A. (2020). Continuous quality improvement in health care (5th ed.) [e-book]. Jones &Bartlett Learning .

Tanya Perkins

replied toCrystal Young

Mar 6, 2022, 8:40 PM(edited)

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Replies to Crystal Young

Crystal you are correct and it has been shown that Six Sigma is a quality model that focuses on efficiencies within the workflows of various organizational settings. Also, Six Sigma integrates safeguard techniques within the workflow to enhance quality and satisfaction. Moreover, these safeguards are especially critical in the healthcare setting and for standardizing the discharge process (Niñerola, 2020). It is true that the obstetrics unit relies heavily on efficient workflows to safely discharge and admit patients. I further agree that safety measures should be in place prior to discharging patients from an acute care setting. Patients’ receiving care in the obstetrics unit have mixed acuity levels, so it is necessary to know past medical and current medical histories of the patients being served on the obstetrics unit upon admission, while there and especially prior to discharging a patient to home (Samonte & Vallente, 2020).

Yes, like many other areas where quality care is essential, health care processes must be reorganized in the obstetrics unit. The best way to achieve the desired outcomes is by applying a quality model like Six Sigma. Six Sigma is a management system that seeks to improve the efficiency of processes, reducing defects to achieve improved quality and customer satisfaction. Since Motorola implemented it in the mid-1980s, it has become a powerful management tool whose objective is to achieve a quality level of 99.99 %. For this purpose, it uses a stepwise process called DMAIC, whose acronym means Define, Measure, Analyze, Improve and Control. These stages allow improving the quality of any process at the project level or throughout the organization (Niñerola et al., 2020). Most obstetrics unit are required to have an outcome goal of safety, efficiency, privacy and care for the women and infants that the unit serves. These measures should be in place when admitting to the unit, during the stay on unit, and during discharge process. Prior to discharging a patient, the needs of the mother and baby as well as other female patients on the obstetrics unit are thoroughly considered (Samonte & Vallente, 2020).

References

Samonte, P. R. V., & Vallente, R. U., (2020). Discharge planning. Salem Press Encyclopedia of Health.

Constantine Dapilma

Posted Date

Mar 5, 2022, 3:07 AM

Status

Ungraded

Replies to Latrice Hatch

The Six Sigma Approach

The obstetrics unit is a sensitive operating area where all processes should be effective and efficient. Inefficiencies in the discharge process can have profound implications on maternal care. Like many other areas where quality care is crucial, health care processes must be streamlined in the obstetrics unit. The best way to achieve the desired outcomes is by applying a quality model.

When tasked to utilize the Six Sigma approach, the nurse leader must understand the basic principles of the model and the processes it recommends to improve the care quality. According to Ross (2019), the Six Sigma approach is primarily about reducing defects to optimize operations and reduce variations between the current and the desired quality of care. Given this, the nurse leader must be conversant with the flaws hampering the discharge process in the obstetrics unit. For instance, working in silos and failure to use alert systems are common barriers to a standardized discharge process (Ward et al., 2022). Understanding the basics is the starting point before the nurse leader adopts a structured approach to solve the problem and prevent its recurrence.

Six Sigma’s structured approach has five main steps. They include defining, measuring, analyzing, improving, and controlling (Ahmed, 2019). The problem must be defined to understand its scope. The causes are then analyzed, followed by evidence-based interventions to address the issues hampering the discharge process. For instance, the obstetrics team can stop functioning in silos and work in teams. Electronic time stamps can also be adopted to reduce delays as much as possible. Control measures to prevent recurrence include continuous training, team building, and progressive assessment of processes to ensure that all procedures meet the expected quality standards.

The Six Sigma model provides a structured process for quality improvement. It presumes that defects in health care processes are the main barriers to optimal quality. As a result, health care quality can only be optimized by identifying and removing the defects.

References

Ahmed, S. (2019). Integrating DMAIC approach of Lean Six Sigma and theory of constraints toward quality improvement in healthcare. Reviews on Environmental Health, 34(4), 427-434. https://doi.org/10.1515/reveh-2019-0003

Ross, T. K. (2019). Applying Lean Six Sigma in health care. Jones & Bartlett Learning.

Ward, M. E., Daly, A., McNamara, M., Garvey, S., & Teeling, S. P. (2022). A case study of a whole system approach to improvement in an acute hospital setting. International Journal of Environmental Research and Public Health, 19(3), 1246. https://doi.org/10.3390/ijerph19031246

Tanya Perkins

replied toConstantine Dapilma

Mar 6, 2022, 8:30 PM(edited)

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Replies to Constantine Dapilma

Constantine, you are precise regarding the obstetric unit being a sensitive operating area where all processes should be effective and efficient. I also agree that any inefficiencies in the discharge process can have profound implication on maternal as well as neonatal care. Yes, like many other areas where quality care is essential, health care processes must be reorganized in the obstetrics unit. The best way to achieve the desired outcomes is by applying a quality model like Six Sigma. Six Sigma is a management system that seeks to improve the efficiency of processes, reducing defects to achieve improved quality and customer satisfaction. Since Motorola implemented it in the mid-1980s, it has become a powerful management tool whose objective is to achieve a quality level of 99.99 %. For this purpose, it uses a stepwise process called DMAIC, whose acronym means Define, Measure, Analyze, Improve and Control. These stages allow improving the quality of any process at the project level or throughout the organization (Niñerola et al., 2020). Most obstetrics unit are required to have an outcome goal of safety, efficiency, privacy and care for the women and infants that the unit serves. These measures should be in place when admitting to the unit, during the stay on unit, and during discharge process. Prior to discharging a patient, the needs of the mother and baby as well as other female patients on the obstetrics unit are thoroughly considered (Samonte & Vallente, 2020).

References

Samonte, P. R. V., & Vallente, R. U., (2020). Discharge planning. Salem Press Encyclopedia of Health.

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