Treatment and discharge in hospitals: Practice elements

Nurse practitioners (NPs) who work in Ontario hospitals provide care for both inpatient and outpatient populations while collaborating and consulting with the interprofessional team as needed to address patient care needs. Since July 1, 2011, Ontario hospital NPs have been authorized to admit, treat and discharge inpatients. NPs view treatment and discharge planning, however, as one of several components within a comprehensive plan of care developed by NPs in collaboration with the inter-professional team.

Involving patients

A central part of the NP role is to actively involve patients and families in the process of developing a therapeutic plan of care and monitoring patients’ response of treatment progress towards specific goals. NPs assess patients and their readiness for discharge throughout the hospital stay and work with interprofessional care teams to ensure discharge arrangements align with a safe transfer of accountability to the primary (or other) care provider.

Maximizing patient access and flow

NP accountabilities for treatment and discharge vary according to the setting. Depending on the complexity of co-ordinating the discharge or transition, as well as the level of access to members of the interprofessional teams (that may or may not include discharge planners), treatment and discharge may include:

·         Providing treatment

·         Planning care and assessing readiness for discharge

·         Creating plan to transition care to the right provider, at the right time, to the right place

·         Developing and communicating the discharge plan with patients, families and the inter-professional team

·         Communicating  transfer of accountability to another care setting / care provider or coordination of care services in the community

·         Writing the discharge order and completing the prescriptions and appropriate chart documentation (e.g., health record summary), and

·         Performing medication reconciliation.


Improving efficiency and effectiveness

In the past, NPs were required to perform many of these functions through cumbersome work around pathways, using medical directives to meet the legal requirements of providing routine patient care. However, hospital adoption of NP treatment and discharge eliminates the need for this inefficient layer of administration and enables NPs to focus on providing direct processes of care that improve the effectiveness and efficiency of discharge while ensuring full accountability during the discharge process.


Promoting innovation and a higher quality of care

Due to the legislative and regulatory amendments in Ontario allowing NPs to be more fully utilized in the health system, hospitals now have an ideal opportunity to maximize NP contributions and to explore ways to improve inpatient processes within the inter-professional team. Research has consistently demonstrated that care by the hospital NP contributes to quality patient care as well as cost effectiveness (please see the sections of this toolkit titled "Evidence: Quality and Economic").  NPs facilitate more streamlined care processes, including timely treatments and discharge. Such leading practices keep the entire health-care team aware of each patient’s readiness for transfer of care to another provider and discharge from the hospital setting.

For sample tools and resources, go to the Tools for Implementation section.