Patient throughput remains one of the greatest operational challenges in acute care settings. Delays in discharges contribute to ED and PACU holds, prolonged wait times, reduced inpatient capacity, and increased stress for both families and care teams. At Richmond, these challenges prompted a frontline-driven solution grounded in data, evidence, and collaborative practice.
On January 2, 2024, Vivian Ochiagha, MSN, RN, CMSRN, Staff Nurse IV, met with Associate Chief Nurse Executive Tia B. Newell MSN, RN, NEA-BC, to review discharge performance metrics. Unit data showed an average discharge time of 350 to 400 minutes and only 25 to 30% of discharges occurring before 1 p.m., below the hospital benchmark of 40%. Bedside nurses also cited barriers including limited time for discharge teaching, delays after discharge orders, and competing demands that prevented timely admissions and documentation.
Recognizing the need for dedicated support, Ochiagha led the development and pilot of the Admission, Discharge, and Transfer Registered Nurse (ADT RN) role. After conducting a literature review demonstrating improved satisfaction and throughput with dedicated admission/discharge nurses, Ochiagha formally accepted the role on January 3, 2024, and launched the initiative.
The ADT RN pilot produced measurable and sustained improvements in patient throughput and nursing workflow. Discharge times were significantly reduced, and the percentage of discharges completed before 1 p.m. increased, steadily trending up. The role also contributed to shorter emergency department and post-anesthesia care unit hold times, improving overall patient flow and bed availability. Nurses reported higher job satisfaction due to decreased workload pressure and increased support with time-intensive tasks, allowing them to spend more time on direct patient care. Patients expressed greater satisfaction as well, noting smoother admission processes and more timely discharges. Due to the success of the pilot, leadership approved budget allocation for two full-time ADT RN positions in 2025, which is an endorsement of the initiative’s effectiveness and the value to hospital operations.
This project highlights how direct care nurses drive innovation when empowered through data, shared governance, and evidence-based practice. Ochiagha’s leadership exemplifies Magnet standards by improving operational efficiency, enhancing patient outcomes, and strengthening nursing practice across the unit.