In some areas with early supported discharge schemes, Saturday working is becoming more commonplace. ‘If you read one thing today, make sure it’s Vicky Neville’s open letter’, 28 June, 2010 Hospital Discharge Planning www.nextstepincare.org ©2011 United Hospital Fund 2 Many people start discharge planning with unrealistic expectations because they have inaccurate information about what insurance will pay for and for how long. 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. Increased attention is 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. Discharge Planning in the Home Health Care Setting. The plan should include a brief analysis of local health and social care services available to support people who are discharged from hospital. A brief overview of the 10 key principles of effective discharge planning from a nursing perspective. a significant reduction in length of stay for inpatients; the development of a sustainable and scalable approach that could be used trust-wide. A discharge‐checklist tool was created to facilitate safe discharge from hospital.RESULTSThe final checklist describes the processes necessary for a safe and optimal discharge and recommended timeline of when to complete each step, starting from the first day of admission. The key messages are: check it out, ask the patient and make it happen. Funding issues, change of residence or increased care needs that need to be negotiated between health and social care make discharge complex. 2. 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). Similar themes that are displayed in principle 3 are discussed in principle 1 in both the DH (2010) and RCN (2010) discharge planning guidance, with the focus leading towards prompt planning of discharge. 4. Discharge planning has been identified 9. The 10 steps of discharge planning. Each clinical area needs to decide a structure for the future that takes into account decision makers, regardless of profession. Robust systems to gather patient information have to be in place – this information must then be shared with the multidisciplinary team to ensure early engagement in the discharge process. Key stakeholder buy-in and shared ownership, with clarification of roles and responsibilities. Information exchange and collaboration between care providers are essential, but deficits are common. Simple discharge can be executed at ward level with the multidisciplinary team. Discharge checklists are seen more commonly in integrated care pathways, often for surgical conditions. The advantage of this differentiation is that it should enable discharge planners to recognise when simple becomes complex. Hospital discharge is a complex and challenging process for healthcare professionals, patients, and carers. 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. Many patients who are discharged from hospital will have ongoing care needs that must be met in the community. 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. 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. Theme: Quality improvement Topic: Quality Resource type: Improvement guide Source: ACT Academy Published on: 17 January 2018 (0) Add to favourites; Share this page Facebook; Twitter; LinkedIn; Email; This guide to better discharge planning can help reduce length of stay and ensure patients are ready to leave hospital, thereby reducing unnecessary readmissions . ÔC¾x¶{ Principle 1: Plan for discharge from the start. The aim of discharge planning is to reduce hospital length of stay and unplanned readmission to hospital, and improve the co-ordination of services following discharge from hospital. This area of practice has proved extremely difficult to implement and embed within NHS organisational philosophy. The key difference between this and step 8 is decision making. Ideally, only one plan should be central to the discharge process; this will avoid confusion and duplication of documentation, and should ensure transparency. Measures to facilitate joint working across health and social care agencies were introduced by the Department of Health (DH's) National Plan for Social Care for Adults in England in 2005. These steps include identifying whether the person has simple or complex discharge needs, setting an expected date of discharge/ transfer and reviewing treatment plan with the person on a daily basis. 12. The discharge process in the NHS now encompasses a huge breadth of viable alternatives to hospital, ultimately aimed at speeding up patients’ discharge and frequently entailing new – and sometimes innovative – steps for assessment and referral. Time can be translated into money and, Early discharge planning. The Department of Health's guidance for England also said that discharge planning from a hospital is a process, instead of an isolated event, which should start at the earliest opportunity [17, 18]. 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. For example, admissions after 5pm will be reviewed by the whole team the next day on ward rounds; these therefore become inextricably linked to management plans (Lees et al, 2006). These documents are extremely relevant to the new policy on discharge. Develop a clinical management plan for every patient within 24 hours of admission. Principle 1: Plan for discharge from the start; Principle 1: Plan for discharge from the start. This concern needs to be balanced with effective timely discharges where communication and coordination are the essence of good practice (Macleod, 2006). The process for improvement used proactive discharge planning based on the common failure reasons for patients staying beyond 2 h: medication, consults and physician delays. Identify whether the patient has simple or complex discharge and transfer planning needs, involving the patient and carer in your decision. Liz Lees, MSc, BSc, DipHSM, DipN, RGN, is consultant nurse, acute medicine, Heart of England Foundation Trust, Birmingham. Review, action, progress (RAP) is the process that has been suggested for this (NLIAH, 2008). It includes a ten step plan for successful discharge planning, but no literature was found that Steps 8 and 10 are inextricably linked but looking at them separately means we can consider two different perspectives – organisational processes required to instigate appropriate availability of seven day services and the clinical infrastructure needed to include senior clinical decision makers across a spectrum of care (Royal College of Physicians, 2007). Recent guidance features 10 practical steps to improve the process of patient discharge and transfer – one of the eight high impact actions for nursing and midwifery. Regardless of what we choose to call it, if the estimated date of discharge is to have any meaningful application in practice, its underpinning principles must be understood at three levels: Patient engagement is often absent from the process or conducted on a very superficial level (Sargent et al, 2007). Patient involvement is about genuine and meaningful engagement with patients throughout the entire discharge planning process. Involve patients and carers so they can make informed decisions and choices that deliver a personalised care pathway and maximise their independence. In this step, all patients are assessed so care providers can identify patients who would benefit from discharge planning interventions. The discharge process must work efficiently out of hours and must not add to delays caused by lack of transport, medications and so on. Communication, ensuring multidisciplinary teamworking and assessment are three key roles for discharge coordinators (Rose et al, 2009), as well as the transfer of information that may otherwise be missed (Helleso, 2006). Discharge planning is a routine feature of health systems in many countries. Detailed information is available for the family caregiver on the Next Step in Furthermore, a whole new vocabulary on patient discharge and transfer has developed, such as “capacity”, “flow”, “predictability” and “breaches”. The discharge policy must also support the process; a wise step may be to reconsider the elements within your discharge policy – does the policy include the 10 steps? required for effective discharge planning and transfer from the acute hospital setting (see figure 1). 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. There is potential for the checklist to be merged with the discharge letter and for carbon copies to be given to patients on discharge from hospital. These steps are applicable to all patients including patients with diabetes. To reduce avoidable hospital readmissions, effective discharge planning and appropriate post discharge support care are key requirements. 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. These steps are applicable to all patients including patients with diabetes. Not yetestablished Plans inplace Established Mature Exemplary For simple discharges carried out at ward level, the process should be standardised throughout an entire hospital. Department of Health ... Great Britain. It requires that nurses not only deliver care with the team but also act as patient advocates and understand their The 10 steps of discharge planning Ready to Go – No Delays, one of the High Impact Actions (NHS Institute for Innova-tion and Improvement, 2009), offers a 10-step process for planning the discharge or transfer of patients. 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. õA˜õ߇PËkFáan�Ÿ¼ Chapter 35 Discharge planning 5 35 Discharge planning 35.1 Introduction Planning for a patient’s discharge from hospital is a key aspect of effective care. In addition, facilities in discharge lounges that are inadequate for people with dementia and a lack of appropriate medication or equipment often mean that problems are considered to be a result of patients’ dementia rather than of poor infrastructure supporting discharge plans for this group. Planning the discharge and the safe transfer of patients from hospital and intermediate care’ (2010), issued guidance on discharging older people from hospital and intermediate care services back into the community. Published by Scottish Intercollegiate Guidelines Network (SIGN), 01 June 2010 (2014) Guideline 118: Management of patients with stroke: rehabilitation, prevention and management of complications, and discharge planning - Full guideline. Many pieces of work on safety and service development suggest consultants’ decisions are critical to this (RCP, 2007). For example, discharge and transfer for patients with dementia may require a new type of healthcare worker and new support services that encompass the whole care pathway for a society growing older and living longer with increasing frailty (DH, 2009a). The 10 Steps – „Ready to Go‟ (DH 2010) 23 Appendix B Extract from report, ‘Strategy for Improving Integration of Care Pathways to support discharge from hospital’, presented to the Discharge from Hospital Review meeting on 30/5/13 24 & 25 . 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. It is intended to smooth the transition from facility care to a home setting, or alternate facility. “step up/step down” community bed based services. Background: Discharge planning is a routine feature of health systems in many countries. It may also prevent some failed discharges and help patients and healthcare professionals understand/set expectations. Nursing Times; 106: 25, 10-14. ment of Health outlines 10 key steps to improve discharge (DH, 2010b), one of which describes using nurse or midwife-led discharge (Box 1). Set an expected date of discharge or transfer within 24-48 hours of admission and discuss with the patient or carer. The hospital discharge department exists to assist with discharge planning, and it is the hospital’s responsibility to see to it that the discharge is a safe one. Final Reminders for Discharge Planning Advocates in the Home Health Care Setting. 1 35.3 Clinical evidence 2 Ten studies (11 papers) were included in the review8,16,23,32,33,36,42,52,53,59,64; these are summarised in 3 Table 2 below. The evidence base is gradually increasing – and it is crucial that nursing grasps the opportunity to develop this new way of working as part of the discharge process. It should also include some analysis of the gaps that may exist and where the PCTs jointly (with council and providers) plan to spend the share of the £70m during this financial year according to local priorities. Search results Jump to search results . This article examines the current policy context surrounding discharge in the health service, and gives practical advice on implementing the 10 steps. 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. Although the simplicity and clarity of the new DH policy is refreshing, it is important that nurses are not lulled into a false sense of security about its implementation. The evidence suggests that a discharge plan tailored to the individual patient probably brings about reductions in hospital length of stay and readmission rates for older people admitted to hospital with a medical condition. Essentially, the expected date of discharge is estimated and is intended as a guide for the discharge planning process. In emergency/unscheduled care, robust systems need to be in place to develop plans for management and discharge, and to allow an expected date of discharge to be set within 48 hours. Although the principle of a checklist is not new (Lees, 2006), the concept of using the same one across a trust/organisation and making sure it is developed in collaboration with the primary care trust and social care is new. 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. Quality, Service Improvement and Redesign Tools: Discharge planning Figure 2 The detail below focuses on the key elements of planning for elective discharge for simple discharges, but the approach is similar for day case and simple emergency admissions. 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. The aim is not to replicate information but to ensure that vital aspects of planning are not missed amid the increased activity before discharge. The high impact actions have made nurse led discharge a key deliverable (NHS Institute for Innovation and Improvement, 2009). New guidance outlines a systematic approach to patient discharge. 6. Review the clinical management plan with the patient each day, take any necessary action and update progress towards the discharge or transfer date. For example, if there is no clinical management plan, this alone may cause staff to dismiss the process and “do it their own way”. 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). Some staff rotate into a daily shift coordinator role while others hold the dedicated role of discharge coordinator. Integrated Discharge Planning Documents. carers and the communities they live in, their needs, aspirations, values and their definition of quality of life. Discharge checklists have proven to be a difficult area of practice to sustain. If each ward uses a different set of documentation, this will undoubtedly slow the process of retrieval and discharge from hospital. The principle is to anticipate potential delays and to respond by managing those proactively. This guide to better discharge planning can help reduce length of stay and ensure patients are ready to leave hospital, thereby reducing unnecessary readmissions By NT Contributor, Improving discharge planning and involving more nurses is one of the eight high impact actions. Identify whether the patient has simple or complex discharge and transfer planning needs, involving the patient or carer in your decision. • Start with small, manageable steps toward planning for discharge such as setting weekly goals to review … This step is aimed at managing patient expectations and understanding potential complexities or issues. The 10 steps set out the essential steps in discharge and transfer planning, supported by 10 operating principles. seven-day-a-week proactive discharge planning. Step 2: Identify intervention outcomes, performance objectives and change objectives. Provided that the clinical management Moreover, general awareness must be increased and dementia care must become mainstream in acute and intermediate care settings, not perhaps viewed forever as the domain of “specialists” (DH, 2009b). the end of December 2010. 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. Information exchange and collaboration between care providers are essential, but deficits are common. Emergency and acute medical care Chapter 35 Discharge planning 6 Study design Systematic reviews (SRs) of RCTs, RCTs, observational studies only to be included if no relevant SRs or RCTs are identified. Discharge planning Increasing emphasis has been placed on discharge planning since the publication of the NHS Plan (DH, 2000), advocated the freeing up of acute beds by considering improvements in the way patients could be moved into intermediate or community care settings. Develop a clinical management plan for every patient within 24 hours of admission. This Few services offer adequate provision for people with dementia. Predominantly, but not exclusively, these are likely to involve therapy and social care partners which should be guided by the clinical referrals and actions in the clinical management plan (Sargent et al, 2007). The structure of discharge planning is classified into: (1) informal (ordinary) discharge planning and (2) formal (specialized, structured) discharge planning. 5. • Take steps to understand both the perspectives of the patient and their . 10. 8. 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