Abstract
At New England Deaconess Hospital (NEDH), identifying nursing diagnoses and collaborative problems treated during the patient's hospitalization and saving this information as part of the computerized core clinical data base is essential to a professional practice model for the delivery of nursing care. Providing the patient with concise, easy-to-read discharge instructions and referral agencies with consistent information about the patient's functional status and directions for patient care are important components of delivering high quality patient care. ODISY (the On-line Deaconess Information System) facilitates an automated nursing discharge summary function in addition to an automated medical discharge summary, interdepartmental communication via order entry and results reporting, and other user designed functions that support patient care. Utilization of this function strengthens the multidisciplinary discharge care planning process, increases patient satisfaction, facilitates the identification of nursing diagnoses and collaborative problems treated by nurses and physicians, saves a significant amount of nursing time in the preparation of discharge information, and enables the hospital to meet Joint Commission on Accreditation of Health Care Organizations (JCAHO) standards and state regulations for discharge planning.
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