'Never discharge': concept or reality?

Martie L. Moore, RN, MAOM, CPHQ
Martie L. Moore, RN, MAOM, CPHQ

Recently, I found myself engaged in a rich discussion about the current state of healthcare reform. We were debating the pros and cons of accountable care organizations. I introduced the concept of “never discharging” and the room went silent.

“Never discharge” was a challenge recently given to healthcare executives across America. To understand never discharge, you have to understand the word “discharge.”

Discharge is defined as: 1) To relieve of a charge or load; unload. 2) To remove or send forth. The challenge being brought forth was to never unload, remove or send forth those who trust you with their care. 

How is it that we can change an understood action, ceremonially in nature and entrenched deep in to the culture of healthcare delivery systems? “I am being discharged from the hospital,” skilled nursing facility or other setting is said across America perpetually. 

Maybe it is time to think differently about how we support the health and well-being of the population we are caring for in our care settings. Consider this: Never discharge would have a perpetual plan of care that transverses across the continuum. Can that really be that far out there in concept? I contend it is not. Utilizing standards of practice that guide actions to assure the same type and level of care is given, no matter the setting, is one way to consider never discharge. 

Another concept to consider is what I call influencers. Influencers are underlying conditions that influence negative outcomes in the lives we serve. We can change influencers through our actions.

Consider this about influencers: 22% of patients who develop a new pressure ulcer during a hospital stay will be readmitted within 30 days. Thirty percent of patients who contract Clostridium difficile, or C. diff, will be readmitted within 30 days.

Lastly, another influencer that contributes nearly $55 billion in cost in healthcare is falls with injuries. The research shows that 21% of 30-day readmissions had a fall associated with their readmission.

All three influencers can be prevented. So, consider this: a plan of care that adjusts to the needs of the individual to help prevent and treat skin breakdown. It transverses across settings and “never stays” in the last setting but follows to the next resting stop of healthcare.  Promote skin health through utilization of evidence-based products and practice done in the same manner, standardized across the care settings.

Could we change influencers to no longer being contributors to healthcare costs and human suffering?

Never discharge would hold accountability to a new standard and open the door to new thinking we're all longing for in our healthcare: Partnerships that can lead to positive outcomes in a whole new way. 

Martie Moore is chief nursing officer at Medline Industries and a member of NPUAP's Corporate Advisory Council.

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