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 . Paradoxically, the very roles set up to manage complexity in discharge planning, promoting flow and increased capacity, may cause a loss of the skills and experience to carry out discharge planning across a team. In step 2, we identified the desired outcomes of the intervention and formulated specific performance objectives for the target population, such as writing a complete, accurate and timely discharge letter by the hospital physician. 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. In this step, all patients are assessed so care providers can identify patients who would benefit from discharge planning interventions. This has evolved as a result of cultural, political and financial pressures on the health service. A plethora of outreach services (such as intravenous therapy at home) and rapid access clinics that work with acute medicine and surgical admission units also increase the pace of discharge or transfer. The guidance describes nine key steps in effective discharge and transfer of care that can facilitate faster, safer discharges for patients (see graphic). Discharge checklists are seen more commonly in integrated care pathways, often for surgical conditions. Inspired by an article in HSJ in 2012 and the Ready to Go guidance issued by the Department of Health in 2010, Ashford and St Peter’s Hospitals Foundation Trust set out to develop a programme aimed at achieving two things:. For example, if there is no clinical management plan, this alone may cause staff to dismiss the process and “do it their own way”. To order via TSO shops and official agents: Visit our, Exploring the principles of best practice discharge to ensure patient involvement, 100 years: Centenary of the nursing register, 2020: International Year of the Nurse and Midwife, Nursing Times Workforce Summit and Awards, Ready to Go? 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. This step applies to all patients who are admitted for care in a facility, including a short-term care hospital, inpatient rehabilitation facility, long … The 10 steps of discharge planning. Department of Health Publication year: 2010 ... organisational review and audit; and seven-day-a-week proactive discharge planning. required for effective discharge planning and transfer from the acute hospital setting (see figure 1). 7. Discharge planning is a care process that aims to secure the transfer of care for the patient at transition from home to the hospital and back home. The plan should include a brief analysis of local health and social care services available to support people who are discharged from hospital. Time can be translated into money and, Liz Lees, MSc, BSc, DipHSM, DipN, RGN, is consultant nurse, acute medicine, Heart of England Foundation Trust, Birmingham. Furthermore, the numerous types of documentation used to catalogue discharge communications in hospitals and intermediate care settings make planning a more complex process. This step is aimed at managing patient expectations and understanding potential complexities or issues. “step up/step down” community bed based services. The structure of discharge planning is classified into: (1) informal (ordinary) discharge planning and (2) formal (specialized, structured) discharge planning. The table below details 10 key steps to safe and timely discharge (*adapted from: Ready to go, DH 2010). It requires that nurses not only deliver care with the team but also act as patient advocates and understand their But effective discharge planning can ensure that that the patient leaves the hospital in a timely fashion, has continuity of care and remains safe and healthy, without the need for readmission. This concern needs to be balanced with effective timely discharges where communication and coordination are the essence of good practice (Macleod, 2006). As with any health policy, Ready to Go? õA˜õ߇PËkFáan�Ÿ¼ This review gives an introduction to, and taster of, our newly launched Nursing Times Learning unit on discharge planning The key principles of effective discharge planning discharge plaNNiNg learNiNg objecTives This learning unit is free to subscribers and £10 + VAT to non-subcribers at Plan the date and time of discharge early Many patients who are discharged from hospital will have ongoing care needs that must be met in the community. Although it will never replace the role of the multidisciplinary Strategically – to predict overall hospital capacity; Operationally – to assess progress and outcomes of clinical plans; Individually – for patients to understand the expectations, limitations and engagement required from them in the process of planning discharge (Lees and Holmes, 2005; DH, 2004). The new blended learning nursing degree at the University of Huddersfield offers…, Please remember that the submission of any material is governed by our, EMAP Publishing Limited Company number 7880758 (England & Wales) Registered address: 7th Floor, Vantage London, Great West Road, Brentford, United Kingdom, TW8 9AG, We use cookies to personalize and improve your experience on our site. 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). This study is a 3-staged process to develop, pretest and pilot a framework for an effective discharge planning system in Hong Kong. Many studies showed that discharge planning may increase patient satisfaction, and some studies showed reduced hospital length of stay and reduced readmission to hospital, but no evidence that it reduced health-care costs. Nursing Times; 106: 25, 10-14. Background: Discharge planning is a routine feature of health systems in many countries. ‘If you read one thing today, make sure it’s Vicky Neville’s open letter’, 28 June, 2010 Further supportive materials and examples of good practice are available from the linked website. The key difference between this and step 8 is decision making. Identify whether the patient has simple or complex discharge and transfer planning needs, involving the patient and carer in your decision. Junior doctors have an important role to play in planning a patient’s discharge form hospital #### Summary points Discharge planning is a process that aims to improve the coordination of services after discharge from hospital by considering the patient’s needs in the community. It is often a challenge to know where to start implementing a new policy. Definition Nurse or midwife-led discharge is the del-egation of responsibility for the discharge of a patient according to an agreed plan with specific criteria. Sometimes separate, conflicting plans may be developed, for example, if a patient is transferred to a series of wards after admission. 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. úëÉÁ#fP¨:x�íUU¿ÙÁ¡ßŒr©4ƒk( i¿>ئ� >é/É)å¢í²!¹Â. Multidisciplinary teamworking over seven days in hospital settings also requires service provision in primary and social care at the same time to speed up patient discharges. 4. • Be honest with your providers in the type/kind of discharge support you need. 10. 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. plan was started on admission of the patient, reviews with them should be a relatively straightforward process. 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. 4.4 Action steps 40 4.5 Practical examples 40 4.6 References 42 Appendices 4.1 Carer’s assessment checklist 43 4.2 Carer’s assessment and care plan 44 4.3 Patient’s and carer’s leaflet 45 Contents. Principle 1: Plan for discharge from the start; Principle 1: Plan for discharge from the start. If we consider elective care first, this step can be started before admission in the preoperative admission phase and may take the form of a screening tool, risk assessment or care pathway. Liz Lees, MSc, BSc, DipHSM, DipN, RGN, is consultant nurse, acute medicine, Heart of England Foundation Trust, Birmingham. Discharge Planning in the Home Health Care Setting. These steps are applicable to all patients including patients with diabetes. In some cases, it is likely that the plan will form part of a multidisciplinary team meeting or will be used in one, depending on their frequency. The principles discussed in this article should help hospital trusts to apply a systematic approach to the discharge planning process and prevent readmissions while improving the quality of patient discharge. Its title – Ready to Go? The 10 steps of discharge practice are: 2 1. A brief overview of the 10 key principles of effective discharge planning from a nursing perspective. The steps necessary to appeal a hospital discharge decision or to file a complaint about the quality of care. 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. 1.2 National/local context and evidence base The commissioning intentions set out in this specification have been informed by the NHS Dorset Strategic Plan for a Healthier Dorset 2010- 2014 which set out the key priorities for health care in Dorset. Support for discharge planning Support for discharge planning Sturdy , Deborah 2010-03-23 00:00:00 Picture credit: Jupiterimages Ensuring effective discharge or transfer is becoming increasingly difficult because, although developments in treatment and care are helping to reduce inpatient length of stay, the needs of the individuals coming in and out of acute and intermediate care … Effective discharge planning is crucial to care continuity. The End of Life Care Strategy: Rationa Few services offer adequate provision for people with dementia. The impact of discharge planning on mortality, health outcomes and cost rem … Discharge planning from hospital to home Cochrane Database Syst Rev. Rich sources of information streams are often missed in the activity around assessment and transfer (Helleso, 2006); key sources include GPs, primary care teams and carers, who may provide the mainstay of support yet receive little attention or mention. 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. It is not intended to be exact and is refined with reassessment of patients’ progress set against the clinical management plan (Webber-Maybank and Luton, 2009). THE 10 STEPS Essentially, the expected date of discharge is estimated and is intended as a guide for the discharge planning process. New health and social care policies during 2009 were prolific, perhaps demonstrating the complexity and challenges faced by the health service and social care in developing services fit for patients with dementia while accommodating safe discharge and transfer (DH, 2009a; 2009b). 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. Department of Health Publisher: Great Britain. Background: Discharge planning is a routine feature of health systems in many countries. 10. Key stakeholder buy-in and shared ownership, with clarification of roles and responsibilities. To ensure effective and efficient discharge practice, clinical staff and managers have to understand the interactive dynamics of new terminology, new services and new process steps not only in the context of their clinical area but also across the hospital and community. The judgment concluded that the courts have no general power to monitor the discharge of the Local Authority's functions, but that a Local Authority that failed in its duties to a child could be challenged under the Human Rights Act 1998. Clinical management plans do not have to be prescriptive – they should serve as a guide and be revisited if/when patients move through the continuum of care (Lees and Delpino, 2007). The advantage of this differentiation is that it should enable discharge planners to recognise when simple becomes complex. This article examines the current policy context surrounding discharge in the health service, and gives practical advice on implementing the 10 steps. Discharge planning is a care process that aims to secure the transfer of care for the patient at transition from home to the hospital and back home. Steps 6 and 7 suggest patient involvement at two levels, with patients being: adequately informed to enable choice; and, where required, to assess their progress according to the choices made. Without doubt, “out of hours” services and “winter pressures” are vastly outdated concepts in discharge planning and accommodating capacity over seven days. 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