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Nurse-led discharge 'effective in reducing length of stay'

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Nurse-led discharge has been highlighted as an effective way to ensure timely transfer of patients in a new study looking at ways hospitals can reduce lengths of stay.

The research, by think tank the Nuffield Trust, involved a literature review, interviews with high performing hospitals that had made significant improvements in length of stay over the last five years, and workshops with clinicians and managers.

The high performing hospitals noted “equipping the senior nursing staff to facilitate discharge, once defined medical criteria have been reached” could lead to faster transfers, particularly at weekends.

But the report – called Improving length of stay: what can hospitals do? – also noted from its workshop discussions that there were “variable levels of availability of nursing staff to facilitate transfers and availability of wider support services, such as pharmacy and transport”.

“While reducing emergency admissions is difficult to achieve, a more effective way to contain the growing demand for beds may be to reduce length of hospital stay”

Nuffield Trust report on hospital length of stay

The report also pointed to previous research which demonstrated the large number of tasks that compete for nurses’ time and attention when working on a ward, such as participating in handovers, taking bloods and chasing results and managing visiting times.

“Reducing the pressure on hospital bed capacity is one of the key challenges currently facing the NHS.

“While reducing emergency admissions is difficult to achieve and hard to sustain, a more effective way to contain the growing demand for beds may be to focus on reducing length of hospital stay,” said researchers.

“[Interviews with clinicians highlighted] variable levels of availability of nursing staff to facilitate transfers and availability of wider support services”

Nuffield Trust report on hospital length of stay

“A striking and typical finding of this data is that up to 50% of the reasons for patients not needing to remain in the hospital were under the direct control of the hospital itself and often relate to internal processes, decision-making and organisation,” they added in the report.

The report recommends six areas for action to help reduce people’s length of stay in hospitals.

These include focussing on the flow of patients – and understanding the operational processes and staffing mix that underpin clinical pathways – maintaining a rapid pace for decision making,  and ensuring support for discharge is in place seven days a week.

It also said trusts should “get the basics right” – such as planning discharge from the point of admission, structured ward rounds and end of life preparation – and stressed management should give staff the freedom to test out changes as part of their daily work.

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Readers' comments (2)

  • Nurse Led Discharge works very well in our Day Surgery Unit. Staff undergo training and assessment.

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  • I work in a community hospital for older rehab and palliation. We are a nurse led unit supported by a small medical team. discharges work well and are started from admission . Our delays are normally waiting for a package of care. some times we have to wait an unacceptable length of time for care to be available

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