The important aspect is to update the plan with the multidisciplinary team and patients (Efraimsson et al, 2003); clinical management plans reflect progress to medical and therapy milestones. This study is a 3-staged process to develop, pretest and pilot a framework for an effective discharge planning system in Hong Kong. In emergency/unscheduled care, robust systems need to be in place to develop plans for management and discharge, and to allow an expected date of discharge to be set within 48 hours. Ready to Go - No Delays, one of the High Impact Actions (NHS Institute for Innovation and Improvement, 2009), offers a 10-step process for planning the discharge or transfer of patients. Review, action, progress (RAP) is the process that has been suggested for this (NLIAH, 2008). From the outset of a patient’s admission, the multidisciplinary team leading their care, plus the patient, their family and carers, all need to have a clear expectation of what is going to happen during their stay. úëÉÁ#fP¨:x�íUU¿ÙÁ¡ßŒr©4ƒk( i¿>ئ� >é/É)å¢í²!¹Â. 1 35.3 Clinical evidence 2 Ten studies (11 papers) were included in the review8,16,23,32,33,36,42,52,53,59,64; these are summarised in 3 Table 2 below. Planning for patient discharge is an essential element of any admission to an acute setting, but may often be left until the patient is almost ready to leave hospital. Further supportive materials and examples of good practice are available from the linked website. Effective discharge has also been a priority area in Australia since 1998. ÔC¾x¶{ For example, admissions after 5pm will be reviewed by the whole team the next day on ward rounds; these therefore become inextricably linked to management plans (Lees et al, 2006). Furthermore, a whole new vocabulary on patient discharge and transfer has developed, such as “capacity”, “flow”, “predictability” and “breaches”. Chapter 35 Discharge planning 5 35 Discharge planning 35.1 Introduction Planning for a patient’s discharge from hospital is a key aspect of effective care. For simple discharges carried out at ward level, the process should be standard-ised throughout an entire hospital. Discharge checklists have proven to be a difficult area of practice to sustain. The hospital discharge department exists to assist with discharge planning, and it is the hospital’s responsibility to see to it that the discharge is a safe one. Department of Health ... Great Britain. The discharge process at all levels is important to trusts’ efficiency and effectiveness and is well worth a comprehensive review – using the 10 step approach. 8. Plan the date and time of discharge early This Few services offer adequate provision for people with dementia. Ashford and St Peter’s Hospitals Foundation Trust has developed a programme to reduce inpatient stays and improve the discharge process, say Mark Hinchcliffe and Chris Bradley . Discharge Planning in the Home Health Care Setting. They form the framework for audit and review of discharge processes and also inform quality improvement in the future. Conversely, in emergency care, advance planning is not possible. Funding issues, change of residence or increased care needs that need to be negotiated between health and social care make discharge complex. The DH document, ‘Ready to go? It includes a ten step plan for successful discharge planning, but no literature was found that Background: Discharge planning is a routine feature of health systems in many countries. The evidence suggests that a discharge plan tailored to the individual patient probably brings about reductions in hospital length of stay and readmission rates for older people admitted to hospital with a medical condition. Not yetestablished Plans inplace Established Mature Exemplary 2 Discharge from hospital: pathway, process and practice, DH (2003) 3 Hospital Admission and Discharge: People who are homeless or living in temporary or insecure accommodation, DH, CLG, Homeless Link and London Network of Midwives and Nurses, (2006) 4 Homeless Link 2010. Step 2: Discuss the pros and cons of discharge to a skilled nursing home versus home and any other issues specific to your situation with the hospital discharge planner. This article emphasises why discharge planning is important and lists the essential principles that should be addressed to ensure that patients leave at an optimum time, feeling confident and safe to do so. The pace of discharge and transfer is such that most clinical areas have developed systems where they have a dedicated coordinator. This step relies on engagement from therapy services, X-ray services, transport, district nursing and intermediate care services; only with the support of seven day working from hospital and community services will continuity over this period be possible (DH, 2004). The purpose of the study was to describe the ability of an evidence-based discharge planning decision support tool to identify and prioritize patients appropriate for early discharge planning intervention. Multidisciplinary team involvement may have been minimal, depending on the time of day of the patient’s admission. Ultimately a management plan should engage and focus the whole team with patients to plan the aspects of care that are needed leading up to the point of discharge. Start planning for discharge or transfer before or on admission. Discharge planning started at pre-admission for elective patients or within 24 hours of , and recorded on discharge planning tool throughout hospital stay Likelihood that discharge plans will be complex assessed within 24hrs of admission Complex or unmet care … 5. Increased attention is Set an expected date of discharge or transfer within 24-48 hours of admission and discuss with the patient or carer. by estimating length of stay, the aim is to focus on carefully planning time and accounting for possible variance (except for an unexpected deterioration in patient condition). Identify whether the patient has simple or complex discharge and transfer planning needs, involving the patient and carer in your decision. With the advent of the Liverpool Care Pathway and the renewed focus on end of life issues, care pathways aim to facilitate rapid discharge for patients who are dying following admission to acute services (NHS National End of Life Care Programme, 2009). Moreover, general awareness must be increased and dementia care must become mainstream in acute and intermediate care settings, not perhaps viewed forever as the domain of “specialists” (DH, 2009b). For simple discharges carried out at ward level, the process should be standardised throughout an entire hospital. Some staff rotate into a daily shift coordinator role while others hold the dedicated role of discharge coordinator. There is potential for the checklist to be merged with the discharge letter and for carbon copies to be given to patients on discharge from hospital. There is also a play on words evident in practice areas: predicted date of discharge and length of stay, estimated length of stay and estimated date of discharge (Lees, 2008). The discharge process in the NHS now encompasses a huge breadth of viable alternatives to hospital, ultimately aimed at speeding up patients’ discharge and frequently entailing new – and sometimes innovative – steps for assessment and referral. Planning the Discharge and the Transfer of Patients from Hospital and Intermediate Care, Living Well with Dementia: a National Dementia Strategy Implementation Plan, Joint Commissioning Framework for Dementia, Achieving Simple Timely Discharge from Hospital: A Multidisciplinary Toolkit, Code of Practice for Integrated Discharge Planning, Facilitating an effective discharge from hospital, Using post-take ward rounds to facilitate simple discharge, High Impact Actions for Nursing and Midwifery, Passing the Baton – A Practical Guide to Effective Discharge Planning, Making effective use of predicted discharge dates to reduce the length of stay in hospital, 100629Exploring the principles of best practice discharge to ensure patient involvement, Winners of the Nursing Times Workforce Awards 2020 unveiled, Don’t miss your latest monthly issue of Nursing Times, Announcing our Student Nursing Times editors for 2020-21, New blended learning nursing degree offers real flexibility, Expert nurses share their knowledge of pressure ulcers in free-to-watch videos, Matron ‘honoured’ to administer first Covid-19 vaccine in UK, Scotland’s nurses to get £500 bonus as Covid-19 ‘thank you’ payment, Tributes to Bristol nurse and mentor following death with Covid-19, PHE updates green book with chapter on new Covid-19 vaccines, Nurses faced with ‘rotten and insect-ridden’ PPE during first wave, Nurse’s cardiac arrest inspires community’s quest for defibrillators, England deputy CNO to become new RCN director for Scotland, Pay lost by striking Northern Ireland nurses to be reimbursed, Healthcare workers ‘seven times as likely to have severe Covid-19’, This content is for health professionals only, This article has been double-blind peer reviewed. 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