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SAFER-f Patient Flow Medicine Bundle

About Early Discharge

Recommended

  • Implementation of a patient visual management system to identify readiness and preparation required for discharge.
  • Escalation of barriers to discharge to unit decision makers/leadership.
  • Preparation of orders, prescriptions, follow-up appointments the day prior to discharge.
  • Use of efficient mechanisms for booking follow-up appointments (where possible, follow-up with clinicians to connect with patients/essential care partners (ECPs) prior to discharge).
  • Discharges occurring 24/7, including weekends.
  • Multidisciplinary team-led discharges guided by clinical and functional criteria for discharge.
  • Inpatient team education re: due to patient complexity alone (e.g. frailty), re-admission can happen.
  • Patient/family education re: risk management, health crisis plan.

Tips to Improve Timely Discharge

Use the Estimated Date of Discharge

  • Patients' progress towards their Estimated Date of Discharge (EDD) should be reviewed and updated daily during Bullet Rounds.
  • The most responsible health care provider (MRHCP) can work collaboratively with the multidisciplinary team (MDT) to establish the Estimated Date of Discharge.
  • Patients, families and essential care partners (ECPs) should be continually kept up to date, so they know when discharge is expected. This ensures expectations about discharge are known.
  • Prioritize discharge dependent factors (e.g. scan, blood test). Discharge work needs to be urgent, not routine.

Patient Transportation

  • Ensure transportation arrangements are in place for most patients before the day of discharge.
  • Ask patient who should be contacted to arrange for transportation home once they are discharged. Engage this essential care partner as soon as possible so they can pick patient up at discharge time established by the facility.

Take Out Drugs and Discharge Letters

  • The majority of discharge prescriptions should be written up beforehand or finalized during the board/patient rounds.
  • Involve pharmacy teams to resolve any constraints which lead to late discharge prescriptions and discharge letters.

Essential Equipment

  • Access any resources a patient may have for acquiring equipment and if none available, contact the Nova Scotia Health Quick Access Equipment Program. Equipment that is in place and available for use in the patient’s home at the time of discharge will help to support a successful discharge.

Patients Who Need Support upon Discharge

  • For those patients who require additional care upon discharge, proactive planning for discharge is important so all necessary arrangements and services, i.e. VON, Home Care, are organized and scheduled for the patient on the day they are being discharged. This will allow for discharge earlier in the day and will preventing trying to arrange services at the last minute for a patient on the day of discharge.
  • Discharges earlier in the day allow for patients to get home in daylight and reorient to the place they call home. If any questions arise once they arrive home, the patient/family/ECPs may have the opportunity to call the unit and speak to someone who was involved in their discharge and more familiar with them before shift change occurs. 

Clinical and Functional Criteria for Discharge

  • Establish clinical and function criteria for discharge so that the MDT and patients/families/essential care partners know what needs to be completed/achieved for discharge.
  • Establishing these criteria makes the plan visible and transparent for MDT and patients/families/essential care partners.

Information to Understand and Reduce Constraints

  • Use data (e.g. percentage of patients discharged before midday) to inform clinical and operational teams.
  • Focus on specific areas to improve earlier discharge times for their patients.
  • Focus on identifying the root cause of the problem by gaining a true understanding of the constraints in the process.
  • Use data and facts to establish an accurate current state picture; avoid myths and assumptions.

(Source: National Health Services)