Navigating Discharge Planning Phone Calls in Orthopedics

Purpose: While a nursing discharge planning processes existed within the ambulatory care orthopedic practice, the post-pandemic changes of the total arthroplasty patient prompted further examination and redesign of the existing processes for scope of licensure, resources utilization and assessment of telehealth standards within scope of practice of the licensed practical nurse (LPN).

Description: The department of orthopedics has a strong history of prioritizing successful dismissal post-surgery processes by addressing dismissal plans early in the perioperative process. During the COVID pandemic, the total joint arthroplasty practice needed to shift to outpatient surgery more quickly than initially planned. This change in practice increased the importance of preoperative discharge planning. To align with organizational practice redesign and role optimization priorities, the previous registered nurse (RN)-led process was converted to a purely LPN-led process and optimized for practice and role efficiency adhering to telehealth best practices.
Reviewed process to determine potential to standardize. Established a standard workflow for communication with multidisciplinary team members. Developed functional work queue to optimize call prioritization and reduce rework. Developed training incorporating telehealth best practices. Standardized the process flows and consolidated documentation for multiple joint replacement procedures.

Evaluation/outcomes data was collected on the discharge planning phone calls to assist in determining call volume of the orthopedic surgical population reached pre- and post-implementation of the new process. Nursing satisfaction was evaluated pre- and post-implementation by anonymous electronic survey method. A work group consisting of orthopedic nurse leaders and departmental LPNs was created to identify inefficiencies in the current discharge planning phone call procedure and seek multidisciplinary input from stakeholders involved in the process. The LPN group created a standardized process, resource toolkit, telehealth best practice education, and electronic health record report to assist with providing an efficient and quality experience for both the patient and the nursing staff.