Estimated Date of Discharge (EDD)

The acute expected length of stay in hospital for a typical patient, calculated by the Canadian Institute for Health Information (CIHI) based on most responsible diagnosis and other variables including patient age, co-morbidities and interventions. ELOS predicts the expected length of stay for acute care only and does not account for alternate level of care (non-acute) days. 

ELOS can be used to help set an EDD for care, discharge and patient flow planning.

Clinical Criteria for Discharge (CCD) help guide the conversation when updating a patient’s EDD. CCD is the minimum medical, functional and social criteria the patient needs to achieve before discharge. CCD outline what needs to be achieved for a patient to return to the place they call home including:

1. Medical: on room air
2. Functional: able to ambulate 30m with stand-by assistance or able to take medications independently
3. Social: Home care services for personal care set up.

Frailty level for patients 65 years of age and older is determined by the CFS score.

• All patients 65 years of age and older must have a CFS score determined within 24hrs of admission to an inpatient unit if not already completed in the Emergency Department (ED).
• The CFS can be used to identify potential functional and social barriers to discharge and guide functional care plans that are crucial to initiate upon admission.
• Knowing a CFS score two weeks prior to admission gives an indication of the patient’s baseline function both physically and cognitively. This helps the team to identify the goals for mobility, transfers, Activities of Daily Living (ADLs), and Instrumental Activities of Daily Living (IADLs) and to determine what targeted interventions can be implemented and what resources should be considered to support the patient’s needs.
• The further a patient is from their baseline CFS score, the more supports that may be required to return the patient to the place they call home where they can continue to work toward returning to their baseline or recovery as close as possible. This directly impacts the EDD.
• Patients transferred to a unit after a prolonged length of stay should have their CFS score reevaluated at the time of admission to the new unit. This score should reflect how the patient has been functioning two weeks prior to admission to the unit, for an accurate reflection of their most recent strengths and challenges. 

Social barriers to discharge require patient and ECP engagement as early as possible to determine caregiver main concerns and involvement, availability of necessary community supports, and assessment of home environment. This is especially important for patients with CFS score of 6 or greater. 

Home First is more than a philosophy; it’s a commitment to ensuring that individuals receive the care they need in the comfort of a place they call home whenever possible. By focusing on timely discharges from hospital and connecting patients with the appropriate resources, Home First supports recovery, independence, and quality of life outside the hospital.

It’s not just about returning home – it’s about staying home with the right supports in place.

Dignity of risk is the right to live life in a way someone chooses, even with risk. It recognizes that daily life is uncertain and that taking normal risks can lead to positive outcomes in quality of life, health and well-being. 

It can be more helpful to risk mitigate with patients and their essential care partners, rather than believe all risks can (or should) be eliminated.

Early discharges help free up inpatient beds sooner, easing emergency department congestion and improving hospital flow allowing patients to access community services, transportation, and follow-up care during regular hours, which can lead to better continuity of care.

• Patients should be discharged from inpatient units before 11 a.m. whenever possible to create flow capacity.
• Regularly achieving discharges before 11 a.m. plays a key role in supporting this process.
• Additionally, discharging patients earlier in the day supports staff efficiency by balancing workloads and allowing more time to focus on new admissions and clinical priorities.

Overall, prioritizing timely discharge fosters proactive care coordination, reduces unnecessary delays, and contributes to a more effective and patient-centered healthcare system.