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Discharge planning

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The discharge process is a crucial part of a patient’s experience of hospital care. Every patient, whether they are admitted for elective care or as an emergency, wants to know how long they are likely to stay in hospital.

Delay in being discharged is an issue that is often identified as something the NHS can improve on, according to patient satisfaction surveys.

In May 2006 the government published guidance pushing for more nurse-led discharge as a way of freeing up beds and achieving its target of an 18-week maximum wait from GP referral to treatment by 2008.

In 2004 the Department of Health also called for senior staff nurses to be put in charge of all ‘simple’ discharges to help meet the four-hour A&E waiting time target.

It published a toolkit to reduce delays in discharging patients from hospital, providing practical advice, fact sheets, and a 10-step guide to improving discharge processes.

Its key points for reducing delays included:
- All patients should have a treatment plan within 24 hours of arrival
- An expected date of discharge should be set within 24 hours of arrival or, in many cases, before admission for elective patients
- The expected date of discharge should be reviewed against the treatment plan daily and changes discussed with the patient
- Ward rounds should be scheduled in a way that allows a daily senior clinical review of all patients.

At least 80% of discharges are classified as ‘simple’, meaning that patients have relatively straightforward health needs that do not require complex planning. These cases mean people are discharged to their own home and have simple ongoing health care needs.

The theory is that changing the way that discharge happens will have a major impact on patient flow and effective use of bed capacity.

The document contains case studies of good bed management such as a nurse-led service at Calderdale Royal Hospital that has cut delayed discharges.

Nurses there are encouraged to talk to patients’ relatives earlier about their ongoing care requirements, book transport for transferring patients from the hospital to their homes, and liaise with pharmacy departments to arrange prescriptions in time for discharge.

The hospital introduced a new process under which patient case notes are stamped with reminders to proceed to nurse-led discharge. Medical staff sign consent forms so patients can be moved on to a nurse-led discharge plan.

Nurse-led discharge planning, however, has not moved forward as quickly as it could in some areas, because some doctors have concerns over safety and there is debate over having rigorous protocols in place for such discharge arrangements.

Updated: September 2006

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