JMIR Publications

ABSTRACT

Background:

Background:

Hospital discharge is a critical yet often inefficient phase of patient care, prone to communication failures, incomplete patient education, and preventable readmissions.

Objective:

This study aimed to apply Failure Mode and Effects Analysis (FMEA) to compare in-person and virtual nurse discharge workflows at a 112-room county hospital that recorded 9,318 discharges in 2023

Methods:

A mixed-methods approach combining structured observational analysis and focus groups with frontline nursing staff, and a comprehensive literature review. Swimlane flowcharts were used to map bedside nurse and virtual registered nurse workflows, and FMEA was applied to identify potential failure modes and assign Risk Priority Numbers based on severity, occurrence, and detectability. At the beginning of each focus group session, participants reported on the steps of the discharge process as they understood them and then provided information about failure modes that might occur at each step, consistent with established FMEA data collection methods.

Results:

Forty-five failure modes were identified across both workflows, comprising 20 in the in-person bedside nurse workflow and 25 in the virtual discharge workflow. The highest Risk Priority Number identified in the in-person workflow was 210, assigned to the failure mode of a nurse being interrupted during the After Visit Summary review. Virtual discharge workflows consistently produced lower Risk Priority Numbers: missed patient questions scored 150 in person versus 60 virtually, and failure to escalate concerns scored 120 in person versus 45 virtually. Virtual Registered Nurse workflows saved bedside nurses approximately 40 minutes per patient's discharge; target recommendations for each identified failure mode were developed.

Conclusions:

FMEA provides an effective framework for identifying and mitigating discharge process failures. Virtual discharge workflows demonstrate superior safety profiles and efficiency compared to traditional in-person methods. Integrating Virtual Registered Nurses reduces bedside nursing workload, improves consistency in patient education, and supports workforce sustainability amid ongoing nursing shortages Clinical Trial: Not applicable