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Nurse-led discharge improves care

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A nurse-led discharge scheme has significantly improved patient care and reduced costs at a London hospital trust.

Working to strict criteria tailored to individual clinical areas, senior nurses at Barts and The London NHS Trust take full control of the discharge process for suitable patients – reducing length of patient stay and freeing up beds more quickly.

Introduced in 2004, the protocol-based policy has been rolled out to most wards and departments. The trust now sees around 600 nurse-led discharges a month. It estimates the policy saved it nearly £2m last year.

All patients suitable for nurse-led discharge are clearly identified by their doctor and the criteria that must be met prior to going home – such as a patient who had a fever having a normal temperature for 24 hours – written clearly in their notes.

Patients are given a provisional discharge date early on so that they can prepare mentally. The nurses organise care packages, take-home medications and transport as soon as possible to avoid any unnecessary delays.

Deidre Norris, nurse consultant in acute medicine at the trust, said: ‘It doesn’t make sense for people who are fit and healthy to be delayed while they wait for a doctor when a nurse can make a sensible decision based on the same medical tests, such as blood pressure and heart rate.

‘Such patients are keen to go home and are also holding back treatment for other patients, such as those in A&E waiting for a bed to become available.’

She added: ‘[The policy] is also brilliant for team morale, as it gives nurses a feeling of empowerment and autonomy.’

Lynn Young, RCN primary care adviser, said: ‘Senior nurses are better placed than consultants to decide when a patient should go home – they are more in tune with the patient’s life, not just their disease, and clearly know when a patient is fit to be discharged.’

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