Implementation of a patient visual management system to identify readiness and preparation required for discharge
Escalation of barriers to discharge to unit decisions 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 clinicians to connect with patients/essential care partners (ECPs) prior to discharge)
Discharges occurring 24/7, including weekends
Multidisciplinary team-led discharges
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 assessed and recorded every day at patient or board/bed rounds.
The most responsible health care provider (MRHCP) can lead this with multidisciplinary team (MDT) support.
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.
Engage patients' essential care partners in picking up patients first rather than asking patients if they would like it their family or friends to bring them home.
Take Out Drugs and Discharge Letters
The majority of medications to take home (TTAs/TTOs) should be written up beforehand or finalized during the board/patient rounds.
Involve pharmacy teams to resolve any constraints which lead to late TTOs/TTAs and discharge letters.
Any problems will be well known by front line clinical teams.
Essential Equipment
Ordering processes should be standardized and simple.
Patients Who Need Support upon Discharge
For those patients that require additional care upon discharge, proactive discharge to assess arrangements should be made to prevent discharge later in the day.
It is inappropriate for frail older patients to be discharged late in the day; therefore plans should be in place to discharge many of these patients earlier in the day.
Clinical and Functional Criteria for Discharge
Establish clear plans (which include physiological and functional criteria for discharge) in medical notes, to facilitate assurance amongst the teams that the patient is discharge ready.
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.
