SAFER-f Patient Flow Medicine Bundle

About All Patients


  • Daily ward rounds driven by met/not met CCD
  • Frailty, mobility and delirium status to inform Estimated Date of Discharge (EDD)
  • Use of CCD milestones for patients to reach
  • Collaboration with patients/families on establishing EDD and CCD
  • Daily communication to patient/families about EDD and CCD via daily rounds
  • Utilize a patient visual management system to visualize patients’ daily activity status and progress towards discharge
  • Red to Green Days Overview
  • Reduce transfers within hospital (as applicable)
  • Repatriation to patient’s local hospital (as applicable)

Estimated Date of Discharge (EDD)

Why is EDD important?

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.

How do you establish an EDD?

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.

When should EDD be updated?

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:

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

Clinical Criteria for Discharge (CCD)

What are Clinical Criteria for Discharge?

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.

Suggested Process When Using Clinical Criteria For Discharge

Liz Lees Deutsch, A Manager’s Guide to Criteria-Led Discharge

Patient Visual Management System

What is the Patient Visual Managment System?

Source: National Health Service

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

4 Qs: Communicating with Patients and Essential Care Partners

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:

  • Does the patient know why they are in the hospital?
  • Does the patient know when they are going home?
  • Does the patient know what tests or treatments they are having today?
  • Does the patient know if they will see a doctor today?

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.


  1. The Ticket Home Program

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:

  • Patient name and consultant, along with sections to fill for the physiotherapist and occupational therapist at time of discharge.
  • It also mentions if patient needs a transport to their home, if their X-ray and take-home medication are provided.
  • The most important part of the card is the section for date of going home, which is added at the time of admission and updated as needed.

The predicted discharge date sets a goal for staff to ensure discharge is possible, but are also educated on importance of safe discharge16.

  1. Bedside White Board
BED # Patient Name
Today's Date Expected Discharge Date
Nurses Physician
Occupational Therapy






Social Work Continuing Care



POC Glucose Weight Most Recent Vital Signs

Source: Nova Scotia Health

  1. Bedside White Board

NHS bedside whiteboard

Source: Healthcare Product Design (HPD) & The Shrewsbury and Telford Hospital NHS Trust - National Health Service