For those patients at risk of an extended length of stay (> 6 days), a multidisciplinary team case conference (review) that includes patients and families is conducted with a "home first" mindset.
During Bullet rounds, patients who are at risk for an extended length of stay should be flagged early in their admission in an effort to minimize an extended length of stay (LOS).
Virtual care (when needed) to ensure all required participants are involved in case review.
Establish clinical criteria for discharge that is communicated to the patient, family and essential care partners so they are aware of what the patient needs to be able to do to go home.
Implementation of the RED to GREEN method.
All team members are responsible for driving a patient review to occur for patients at risk of a > 6-day length of stay.
Flagging of patients that are anticipated to remain on unit at day 6 to ensure most responsible health care provide (MRHCP) (if appropriate), multidisciplinary team, patients, families and essential care providers are available to attend a next-day review.
Communication with patients/families about discharge barriers.
Consideration of frailty and its impact on readiness for discharge.
Consideration of mobility status and its impact on readiness for discharge.
Consideration of delirium and its impact on readiness for discharge.
Transfer to their usual place of residence as soon as they cease to benefit from acute care as the risks of deconditioning, decompensation and other hospital acquired harm increases with each day in hospital.
Assessments in a patient’s home environment are beneficial as assessors are often surprised with a patient’s functional level in their own familiar, comfortable environment.
Prescribing long term “solutions” such as long-term care often sets unnecessary and inappropriate expectations for MRHCP, MDT, patients, families and essential care providers.
Consider dignity of risk—think about risk mitigation or risk management strategies for patients and their families upon discharge.
With effective Bullet Rounds, patients requiring long stay reviews should decline as patients have more days progressing them towards discharge (green days) which helps to achieve shorter length of stays.
