A case study detailing how criteria-led discharge (CLD) was introduced on an acute medical unit at Tameside General Hospital resulting in increased weekend discharge rates.
What was the problem?
In acute medical units (AMUs) across England fewer patients are discharged on weekends because of a lack of medical staff to review patients (NHS Improvement, 2019, NHS Improvement, 2017). Currently all patients in Tameside General Hospital who are potentially suitable for discharge over the weekend, are identified by the nursing team on a Friday and seen by the discharge team on a Saturday and Sunday. An average of 11.9 patients are discharged each weekday compared to 9.2 over the weekend.
This discharge team usually consists only of one consultant and one junior doctor to cover approximately 272 medical inpatient beds, and these ward rounds often occur later in the day. This results in delays to discharge, often overnight until the pharmacy department is open.
What was the solution?
The trainee advanced clinical practitioner introduced a criteria-led discharge (CLD) project to the AMU of Tameside General Hospital. It ran for eight weeks with 23 patients selected for project inclusion. Average discharge rates prior to project implementation were 11.9 discharges on a weekday and 9.2 on a weekend. Following the introduction of criteria-led discharge, average weekend discharges rose to 14.25 discharges.
What were the challenges?
The main barrier to implementation was an initial lack of engagement from junior medical staff who complete the necessary discharge paperwork. Most agreed that completing discharge medications and letters before patient discharge would improve continuity and safety, but some argued it would result in discharge summaries being completed before the full details of the discharge were known. NHS guidance states that discharge letters should be completed within 24 hours of discharge to promote patient safety, prompt referrals and ultimately create continuity of care (NHS England, 2017) but this is often not achieved and completing the letters in advance improves the prospect of meeting this target.
Source: NHS Improvement, 17th January 2020