This NUR 400 Module 7 page shows a complete final project quality improvement proposal on hospital discharge delays, with data analysis, evidence review, the proposed initiative, change leadership, implementation phases, an evaluation table and references. Searches like "nur 400 module 7 assignment", "nur400 module 7 final project" and "nur 400 module 7 example" land here.
The NUR 400 Module 7 example, in full
Ready by Ten, Gone by Three: A Quality Improvement Proposal to Reduce Afternoon Discharge Delays on Two Medical Units
[Student Name]
Southern New Hampshire University
NUR 400: Systems Leadership for Continuous Quality
Final Project
[Instructor Name]
[Date]
The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.
Ready by Ten, Gone by Three: A Quality Improvement Proposal to Reduce Afternoon Discharge Delays on Two Medical Units
Introduction
Every hospital bed has two sides: a patient leaving it and a patient waiting for it. When discharges happen late in the day, patients who are medically ready spend extra hours in the hospital, while people already admitted sit on emergency department stretchers waiting for beds that are still occupied. This proposal addresses that problem on two composite 32-bed medical units in a 280-bed community hospital. It argues that the delay is largely a nursing and care coordination process problem that can be improved by preparing discharges the day before, and it proposes a nurse-led next-day discharge process with measures to test whether the change helps patients on both sides of the bed.
The Organization and the Problem
The two medical units admit about 5,400 patients a year, most through the emergency department. The hospital's mission emphasizes safe, timely, patient-centered care, and its strategic plan names patient flow as a priority because the emergency department regularly holds admitted patients for hours.
A review of 1,210 discharges from the two units over three months showed a clear pattern. The median time of the discharge order was 10:50 a.m., but the median time patients physically left their rooms was 3:05 p.m., a gap of more than four hours. Only 146 of the 1,210 patients, 12.1 percent, left before noon. Staff and patients identified the most common reasons for the gap: waiting for discharge prescriptions to be filled, discharge teaching that began only after the order, transportation arranged on the day of discharge, and final paperwork completed when the nurse had time between other duties. During the same three months, admitted patients waiting for a bed on these units spent a median of 5.4 hours in the emergency department after the admission decision.
The consequences are real. Longer boarding in the emergency department has been associated with higher in-hospital mortality among admitted patients (Singer et al., 2011). Patients who are ready to go home but wait hours for medications or rides lose part of a day and often express frustration in patient experience surveys.
Evidence Review
Hospitals have tested ways to move discharges earlier in the day. At one academic medical center, a multidisciplinary initiative that included next-day discharge planning, early morning huddles and clear targets for each unit raised the share of discharges before noon from a low baseline to a much higher level and was associated with shorter observed lengths of stay and improvements in emergency department flow (Wertheimer et al., 2014).
The evidence is not uniform. An analysis at another academic center found that discharge before noon was not associated with a shorter length of stay once other factors were accounted for (Rajkomar et al., 2016). This finding suggests that a time-of-day target can be met in ways that do not improve flow, for example by holding patients for an extra night so they can leave early the next morning. The lesson for this proposal is that the goal should be to shorten the gap between readiness and departure, not simply to move the clock, and that length of stay must be measured to make sure the change does not keep patients longer.
The Proposed Initiative
The initiative, called Tomorrow's Discharges Today, has four parts. First, a ten-minute afternoon huddle at 2:00 p.m. on each unit, led by the charge nurse with the case manager and hospitalists, will identify patients likely to be discharged the next day. Second, for each identified patient, the nurse will begin discharge teaching that evening using teach-back, the case manager will arrange transportation and follow-up appointments, and pharmacy will be asked to prepare discharge medications for bedside delivery the next morning. Third, a morning check at 8:30 a.m. will confirm which patients remain on track and flag barriers. Fourth, an expected discharge time will be written on the patient's room whiteboard, so patients and families can plan their ride and their day.
Leadership and Change Approach
The initiative requires cooperation across nursing, medicine, case management, pharmacy and transport, so it calls for a leadership approach that builds shared commitment rather than issuing instructions. The nurse managers will act as transformational leaders, sharing the boarding data with staff, connecting the change to patients waiting in the emergency department and inviting staff to design the huddle. The change will be tested through Plan-Do-Study-Act cycles, starting with one unit and one hospitalist team, as described in the earlier milestones. Resistance is expected from staff who worry about adding another meeting and from physicians who prefer to decide on discharge the same morning; keeping the huddle short, and demonstrating early results, will be the main responses.
Implementation Plan
The rollout spans six months. During month one, the team will design the huddle script, the evening teaching checklist and the process for next-morning bedside medication delivery with pharmacy. In months two and three, the process will be piloted on one unit with one hospitalist team, with weekly review of data and staff feedback. In month four, the process will expand to the full first unit and in month five to the second unit. Month six will be used to evaluate results and decide whether to spread the process to other medical and surgical units. Education will be brief and on the unit: charge nurses will learn to run the huddle, and staff nurses will learn the evening teaching checklist.
Evaluation
The evaluation will compare each measure with its three-month baseline, as shown in Table 1.
Table 1
Evaluation Measures for the Discharge Initiative
| Type | Measure | Baseline | Target at month six |
|---|---|---|---|
| Outcome | Median time from discharge order to departure | 4 hours 15 minutes | 2 hours or less |
| Outcome | Discharges before noon | 12.1 percent | 30 percent |
| Outcome | Median emergency department boarding time for patients admitted to the units | 5.4 hours | Reduction of at least 1 hour |
| Process | Next-day discharges identified at the afternoon huddle | Not measured | At least 70 percent of actual discharges |
| Balancing | Length of stay, adjusted for case mix | Current value | No increase |
| Balancing | Readmissions within 30 days | Current rate | No increase |
| Balancing | Patient-reported readiness for discharge | Current survey score | No decrease |
Resources and Cost
The main costs are staff time for design and education, estimated at about $9,000, and pharmacy technician time for bedside medication delivery, estimated at $18,000 for the first six months. No new technology is required. The hospital may gain capacity by freeing beds earlier in the day and reducing boarding, but this proposal does not assume a specific financial return. Results will be presented to the executive team at month six to decide on continued funding.
Conclusion
On two medical units, patients are ready by mid-morning but leave in mid-afternoon, and new admissions queue downstairs in the meantime. The causes, late teaching, same-day medications and rides, and paperwork squeezed between other tasks, are process problems that nurses can help fix. Preparing discharges the day before through a short huddle, evening teaching, advance medication and transport planning and a visible expected discharge time offers a practical solution. Measuring order-to-departure time, boarding and length of stay together will show whether the change helps patients on both sides of the bed.
References
Rajkomar, A., Valencia, V., Novelero, M., Mourad, M., & Auerbach, A. (2016). The association between discharge before noon and length of stay in medical and surgical patients. Journal of Hospital Medicine, 11(12), 859-861. https://doi.org/10.1002/jhm.2529
Singer, A. J., Thode, H. C., Jr., Viccellio, P., & Pines, J. M. (2011). The association between length of emergency department boarding and mortality. Academic Emergency Medicine, 18(12), 1324-1329. https://doi.org/10.1111/j.1553-2712.2011.01236.x
Wertheimer, B., Jacobs, R. E. A., Bailey, M., Holstein, S., Chatfield, S., Ohta, B., Horrocks, A., & Hochman, K. (2014). Discharge before noon: An achievable hospital goal. Journal of Hospital Medicine, 9(4), 210-214. https://doi.org/10.1002/jhm.2154
How this NUR 400 Module 7 example is structured
The final proposal brings the milestones together as one argument addressed to decision makers. It opens with the organization and the problem, measured from both sides of the delay: the time between the discharge order and the patient's departure, and the hours admitted patients spend boarding in the emergency department. The evidence section reviews what is known about discharge timing, including a study that complicates the case. The initiative is stated precisely, followed by the leadership approach and change model. Implementation is phased, and a table defines outcome, process and balancing measures. A short budget and a conclusion addressed to hospital leaders complete the proposal.
Get NUR 400 Module 7 written to your instructions
Send your NUR 400 final project guidelines and rubric, all four milestones and the feedback you received on each. The desk assembles a final proposal around your initiative within 24 to 48 hours, free for your first sample. The paper above is an original model document written by our desk, not a submitted student paper and not an official Southern New Hampshire University document.
NUR 400 Module 7 questions, answered
What does the NUR 400 Module 7 final project usually require?
In most sections the final project is a quality improvement proposal that brings the milestones together: the organization and problem with data, supporting evidence, the proposed initiative, leadership and change theory, implementation and evaluation. Some sections pair it with a presentation. Your guidelines set the length and required parts.
Should a quality proposal include evidence that argues against it?
Yes, when it exists. Acknowledging a study with mixed or negative findings, and explaining how the proposal responds to it, makes the argument more credible to leaders. It also shapes better measures, since the evaluation can test the concern directly.
How do I address cost in a NUR 400 proposal?
Estimate the main costs, usually staff time, education and any technology changes, and explain what the organization may gain, such as fewer boarding hours or shorter stays. Keep estimates reasonable and avoid promising savings the data cannot support.