Date of Degree


Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)




Diana Beckmann-Mendez


Discharge from a hospital is a high-risk period for mental health patients, as 20% experience an adverse event within 30 days of discharge. Poor discharge engagement can lead to complications for recovery, which include an increased risk for readmissions, longer length of stay, increased risk for suicide, and death. Hospital stays cost the United States $377.5 billion dollars per year; there is pressure for hospitals, health plans, and providers to examine the admission and discharge processes to improve healthcare delivery, transition of care, and patient health outcomes. At a South Texas VA, 67.66% of mental health patients attended all their discharge appointments, far below the VA’s national benchmark of 85%.

To improve post-discharge engagement, an interdisciplinary, quality improvement project was conducted on the inpatient mental health units at one of two VA hospitals in South Texas from May 2023 through July 2023. A review of literature identified best practices regarding the discharge of mental health patients as engagement of patients, families, and/or support persons; clinician communication along the transition of care, administration of long-acting injectables, and the utilization of Peer Support Specialists (PSS). After 11 weeks of implementation, data on 62 inpatient charts showed a 3% increase in PSS referrals and an overall 5% increase in post-discharge engagement for FY-23 Quarter 3. The results of the project promote quality care by increasing knowledge on evidence-based practices that support effective discharge planning. Results may also ameliorate the potential adverse events experienced by mental health patients post-discharge and decrease healthcare costs.