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Estimated Date of Discharge (EDD)

Who determines an EDD?

The EDD should be established by the Most Responsible Health Care Provider (MRHCP) in collaboration with the Patient/family/ECP and Multi-disciplinary Team (MDT) within the first 24 hours of admission or upon arrival to a new unit after a transfer.

The EDD should be revisited and updated as required during bullet/multidisciplinary rounds, as more information becomes known about a patient’s condition and discharge plan during their inpatient stay. Changes to the EDD are done in collaboration with the patient/family/ECPs.

Even when the EDD is difficult to determine (e.g. complex discharge), a date must be set and entered in STAR or Meditech!

When to Enter or Update an EDD

EDDs should be entered/updated at the following times:

  • Within 24 hours of admission or arrival to a new unit after a transfer
  • Following a change in a patient’s condition that impacts their length of stay
  • As a result of a delay in discharge due to a change in social support requirements or accessing a community resource/service/equipment
  • Within 48 hours of an anticipated discharge/transfer

With EDDs that are within 48 hours or less, an expected time of discharge will be established and communicated to the patient/family/ECPs. Discharge time is expected to occur before 11am.

How to Set an EDD

Setting an EDD should be based on clinical judgement guided by a patient’s presenting illness/admitting diagnosis with considerations for the following:

  • Patient/family/ECP perspective and healthcare goals
  • Clinical Frailty Scale (CFS) score (for patients 65 years of age and older)
  • Cognitive challenges/delirium
  • Co-morbidities
  • Social circumstances/caregiver involvement/availability of community supports

An initial EDD must be set within 24 hours of admission. 

Recognizing that access to information and assessments may be limited within the first 24 hours of an inpatient admission, the initial EDD should be based primarily on clinical judgement guided by a patient’s presenting illness/admitting diagnosis and, for patients 65 years of age and older, informed by the CFS score. CIHI Expected Length of Stay (ELOS) data for the most common Case Mix Groups (CMGs), located in the EDD Clinical Support Dashboard, can be used as a starting point when setting an initial EDD. 

An EDD can be entered for patients admitted to emergency department overflow or wait units if there is resource capacity to do so. Otherwise, it will be the responsibility of the care team to establish an EDD within 24 hours of arrival to an inpatient unit.

Updating an EDD

EDDs should be regularly revisited and updated as more information becomes known about a patient’s condition and discharge plan. Clinical teams are expected to discuss the EDD during bullet /multidisciplinary rounds and reassess and adjust within STAR or Meditech when necessary.

EDD Requirements

  • EDDs must be established by the Most Responsible Healthcare Provider (MRHCP) in collaboration with the MDT.
  • EDDs must be set/reviewed for each patient as soon as possible- within 24 hours of admission to an inpatient unit or upon arrival to a new unit after a transfer.
  • EDDs must be entered in the admission-discharge-transfer (ADT) system (STAR/Meditech) on the same day that they are set by the care team.
  • Patients/family/ECPs must be included in the planning process with patient’s values and wishes at the forefront. Consider goals of care/chosen levels of intervention.
  • Respect patient’s right to live with risk even in context of dementia and frailty. Be aware of influences such as ageism and overprotective attitudes that may be infringing on this patient goal. 
  • A CFS assessment must be completed for all patients 65 years of age and older.
  • Patients/family/ECPs should be routinely involved and aware of the progress they are making towards their EDD. 
  • Changes in EDDs as well as reason(s) for the change must be communicated to Patients/family/ECPs .
  • EDD should be recorded and updated as necessary, on the patient communication board so that this information is readily available for the patient and their families.

EDD Exceptions

Emergency Department (ED)

EDDs can be entered for patients admitted to emergency department overflow or wait units if the resource capacity exists to do so. It is the responsibility of the care team to review/establish an EDD within 24 hours upon arrival to an inpatient unit. 

Intensive Care Units (ICU)/Intermediate Care Units (IMCU)

The EDD for an ICU/IMCU patient should be reflective of the patient’s anticipated date of discharge, not the date of transfer out of the ICU/IMCU. The declass flag (in STAR/Meditech) should be used to identify patients who are ready for transfer out of the ICU or IMCU.

Alternate Level of Care (ALC)

If a patient is medically stable but remains in hospital, the patient’s ALC status should be assessed. A patient should be designated as ALC within 24hrs of meeting the ALC definition and criteria. ALC designation includes the completion of an ALC Status Form with an identified Support Required.

It may not be possible to determine an EDD for some ALC patients (e.g., patients waiting for long-term care, complex discharges). After a patient is designated as ALC, the EDD will be established in one of two ways:

  • Set EDD based on clinical judgement or known discharge goal date (i.e. date of acquisition of equipment/ services for home). Reassess EDD accordingly.
  • If the patient is placed on a waitlist for placement in the community within LTC, DCS, etc., the process will be to enter an EDD that is December 25 of the next calendar year. Once a placement date for the patient’s new location has been confirmed, this should be entered as the EDD. If the patient is still in hospital on the December 25 EDD, advance the EDD to December 25 of the following year.

Palliative Care

Recommendations for Patients with Palliative Care Needs admitted for Complex management of symptoms and concerns

  • Set EDD based on appropriate CIHI CMG ELOS depending on diagnosis (currently 15 days for patients with palliative care CMG) and other appropriate criteria (e.g., frailty).
  • Ascertain if the patient and family have preferences to be back home by a certain date as part of understanding their goals and values and being person-centered. Adopt such a date as EDD if earlier than the ELOS data. Sensitively communicate the patient's condition, care plans and expectations with patients and family. Ensure EDD is not written on whiteboard in the room except where it forms part of the patient and family’s expressed goal.
  • Flag Palliative Performance Score (PPS) task in C3 Patient Manager (PM) tile if less than 50%.
  • Put the PPS percentage in the comment section in the PM tile, if known.
  • If patients’ condition deteriorates and the patient is expected to die during the admission, change EDD to 25 December of next year and follow the recommendations for patients at the end of life below.

Recommendations for Patients with Palliative and end-of-life care needs reasonably expected to die during their current admission

  • Set discharge disposition as End of life.
  • Flag PPS task in PM tile.
  • Put the PPS percentage in the comment section in the PM tile, if known.
  • Set EDD as 25 December of next year.
  • Ensure EDD is not written on whiteboard in the room. Sensitively communicate the patient's condition, care plans and expectations with family.
  • When patient dies, change EDD to date of death.