All patients and/or their delegates/essential care partners will be involved in setting an estimated date of discharge (EDD) based on the clinical and functional criteria for discharge. This is set assuming ideal recovery and no avoidable delays.
For Nova Scotia Health inpatient units, the Estimated Date of Discharge (EDD) should be established by the care team in consultation with the patient and their family/support person within the first 24 hours of admission or upon arrival to a new unit after a transfer. Once the EDD is confirmed, it is used to help guide teams with discharge planning and to identify anticipated discharges. The EDD can be revisited and updated as more information becomes known about a patient’s condition and discharge plan during their inpatient stay. However, even when the EDD is difficult to determine (e.g. complex discharge), a date must be entered in STAR or Meditech.
The EDD should be guided by the most responsible admitting diagnosis, taking into consideration any comorbidities or physical limitations that may impact discharge. The Canadian Institute for Health Information (CIHI) Expected Length of Stay (ELOS) data for the most common Case Mix Groups (CMGs) can be used as a starting point to identify an EDD, adjusting for a patient’s complexity and/or frailty. The ELOS Report by CMG is available on the Nova Scotia Health Analytics Visualization platform.
A CIHI ELOS view has been added to the EDD Dashboard on the Nova Scotia Health Analytics Visualization platform. This view displays ELOS by CMG for typical patients only (cases without the presence of unusual circumstances such as death, transfer to and/or from other acute care institutions, and an observed length of stay less than or equal to the trim point).
Clinical teams are to discuss the EDD daily during patient rounds to determine if everything is still on track and to mitigate any foreseeable delays in discharge. If the patient’s condition or discharge plans change, the EDD should be reassessed by the team and, if necessary, adjusted within the ADT system (STAR or Meditech). Any updates to the EDD must be discussed with the patient and family, and be clearly communicated with all team members and any other external partners.
EDD should be entered/updated at the following times:
Clinical criteria for discharge (CCD) is the use of agreed upon clinical and functional criteria and their related clinical parameters to guide clinical decisions regarding patient discharge from hospital. It enables a range of registered health care providers (HCPs) to lead a patient’s discharge and makes the clinical discharge plan transparent to the entire multidisciplinary team (MDT) caring for the patient. CCD will work best with morning ward rounds and proactive decision making.
Each member of the MDT can contribute to the CCD and this information can be used to identify the EDD, all of which is clearly recorded in the patient’s notes. CCD and EDD are discussed with the patient/essential care partner(s)/delegate. If there are no complications or concerns, an authorized and designated member of the MDT discharges the patient when the CCD are met.
Liz Lees Deutsch, A Manager’s Guide to Criteria-Led Discharge
National Health Services has adopted a visual management system called “Red to Green”. The Red and Green Bed Days is a visual management approach used to assist inpatient care units with identifying wasted time in a patient’s journey and is part of the SAFER‑f patient flow bundle.
This approach is used to identify and reduce internal and external delays with patients’ progression to discharge. It is outlined in Health Care Provider Information Sheet: Red and Green Bed Days:
You may find the Red to Green visual management approach does not fit the needs of your unit. Consider adopting an alternate approach that best fits. For example:
Source: Nova Scotia Health
At the centre of our health care system are the people that receive the care that we provide. Patients’ acute care experience should focus on their involvement and personal control, and knowing and understanding what to expect during their admission.
As you interact daily with the patients admitted on your unit, consider whether the information you provide them is at a minimum in line with the following four questions:
Through team communication and rounding methods such as patient bedside or bullet rounds, health care teams should have this information readily available to provide patients. Lack of clarity on the answers to any one of these four questions can result in delays, frustration and confusion for the patient/essential care partners/delegates.
The above information is available as a Health Care Provider handout and a Patient Handout for distribution on your unit:
How this information is communicated will depend on the approaches used by your team to communicate with patients. It is also important that patients feel encouraged to ask these questions when interacting with their health care team.
Examples
The initiative was aimed to improve patient flow by implementing a “ticket home” program. It is an A4 laminated card on a patient’s bedside and is easily visible.
The card contains:
The predicted discharge date sets a goal for staff to ensure discharge is possible, but are also educated on importance of safe discharge16.
| BED # | Patient Name | ||
| Today's Date | Expected Discharge Date | ||
| Nurses | Physician | ||
| Occupational Therapy |
Function Goal |
||
| Physiotherapy |
Function Goal |
||
| Social Work | Continuing Care | ||
|
Diet
|
POC Glucose | Weight | Most Recent Vital Signs |
| Comments | |||
Source: Nova Scotia Health
Source: Healthcare Product Design (HPD) & The Shrewsbury and Telford Hospital NHS Trust - National Health Service