A Project Proposal for Discharge Strategies for Unhoused Patients

This Doctor of Nursing Practice project is a practice-focused executive leadership proposal addressing inconsistent discharge planning for unhoused surgical patients in an acute care hospital. Unhoused patients experience disproportionately poor outcomes, including prolonged length of stay, elevated 30-day readmission rates, and fragmented transitions of care. The practice-focused question guiding this project asks whether development of a standardized, housing-informed discharge planning program could improve transitions of care and reduce length of stay and readmissions when compared with current nonstandardized practices. Analytical strategies included synthesis of peer-reviewed literature, review of internal quality and utilization data, assessment of community-level housing instability trends, and application of implementation science frameworks to evaluate feasibility, fit, and acceptability. A comprehensive literature search yielded 10 relevant studies: three Level II, four Level III, and three Level V evidence sources. Evidence consistently identifies homelessness as an independent predictor of increased utilization and costs. Major products of this project include an executive-ready proposal consisting of a standardized clinical practice guideline, logic model, implementation plan, budget with return-on-investment analysis, and evaluation framework. Findings suggest the proposed program represents a feasible opportunity to improve care coordination and operational efficiency. The project advances positive social change by addressing housing instability as a structural determinant of health. By embedding more informed discharge planning into surgical workflows, the organization can provide more compassionate care and reduce disparities among unhoused patients.