Discharge planning involves a coordinated effort between the patient/resident, caregiving professionals, family members, and community supports. Support for discharge planning Support for discharge planning Sturdy , Deborah 2010-03-23 00:00:00 Picture credit: Jupiterimages Ensuring effective discharge or transfer is becoming increasingly difficult because, although developments in treatment and care are helping to reduce inpatient length of stay, the needs of the individuals coming in and out of acute and intermediate care … Patient involvement is about genuine and meaningful engagement with patients throughout the entire discharge planning process. In elective care, planning should begin before admission. The advantage of this differentiation is that it should enable discharge planners to recognise when simple becomes complex. 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). 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. The aim is not to replicate information but to ensure that vital aspects of planning are not missed amid the increased activity before discharge. Patient choices in terms of using supporting services in intermediate care, care pathways and/or dementia care need to be considered, as involvement is a core principle rather than a one off action. 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). The key difference between this and step 8 is decision making. Information exchange and collaboration between care providers are essential, but deficits are common. 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 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. The following documents are available: Integrated Care Guidance a practical guide to discharge 9 step checklist (March 2014) Integrated Care Guidance, a practical guide to discharge and transfer from hospital (March 2014) Department of Health Publisher: Great Britain. The process used on each ward must be the same, underpinned by specialist aspects of discharge planning relating to the individual area. Plan the date and time of discharge early 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. (DH, 2010) must be considered together with previous policies (Health Service Executive, 2008; National Leadership Innovation Agency for Healthcare, 2008; DH, 2004; 2003). 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. 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. New guidance outlines a systematic approach to patient discharge. Inspired by an article in HSJ in 2012 and the Ready to Go guidance issued by the Department of Health in 2010, Ashford and St Peter’s Hospitals Foundation Trust set out to develop a programme aimed at achieving two things:. They form the framework for audit and review of discharge processes and also inform quality improvement in the future. The steps necessary to appeal a hospital discharge decision or to file a complaint about the quality of care. The discharge process at all levels is important to trusts’ efficiency and effectiveness and is well worth a comprehensive review – using the 10 step approach. by estimating length of stay, the aim is to focus on carefully planning time and accounting for possible variance (except for an unexpected deterioration in patient condition). 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. Ten steps set out the essential processes in discharge and transfer planning and are supported by 10 operating principles. Step 2: Identify intervention outcomes, performance objectives and change objectives. Some staff rotate into a daily shift coordinator role while others hold the dedicated role of discharge coordinator. THE 10 STEPS The principle is to anticipate potential delays and to respond by managing those proactively. 8. 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. Lees L (2010) Exploring the principles of best practice discharge to ensure patient involvement. Planning the Discharge and the Transfer of Patients from Hospital and Intermediate Care – should leave nurses in no doubt that the scope of discharge practice has evolved significantly. For simple discharges carried out at ward level, the process should be standard-ised throughout an entire hospital. õA˜õ߇PËkFáan�Ÿ¼ Visit our, Exploring the principles of best practice discharge to ensure patient involvement, 100 years: Centenary of the nursing register, 2020: International Year of the Nurse and Midwife, Nursing Times Workforce Summit and Awards, Ready to Go? Although the 10 steps are not prescriptive, they should all be considered to prevent a collapse of the entire system. 5. 1. A new policy to guide the discharge or transfer of patients from hospital and intermediate care was published earlier this year (Department of Health, 2010). This article emphasises why discharge planning is important and lists the essential principles that should be addressed to ensure that patients leave at an optimum time, feeling confident and safe to do so. This article emphasises why discharge planning is important and lists the essential principles that should be addressed to ensure that patients leave at an optimum time, feeling confident and safe to do so. Order Essence of Care 2010 online from the TSO Bookshop; To order by telephone: Please call +44 (0)870 243 0123 Textphone +44 (0)870 243 3701. Its title – Ready to Go? The steps are based on good practice previously identified, used and evaluated by service providers Simple discharge (inpatient or day case) 1. 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. 12. In some areas with early supported discharge schemes, Saturday working is becoming more commonplace. There is also a play on words evident in practice areas: predicted date of discharge and length of stay, estimated length of stay and estimated date of discharge (Lees, 2008). Discharge planning is a care process that aims to secure the transfer of care for the patient at transition from home to the hospital and back home. 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, if there is no clinical management plan, this alone may cause staff to dismiss the process and “do it their own way”. For each step the Lean methodology has been used. A brief overview of the 10 key principles of effective discharge planning from a nursing perspective. The 10 steps of discharge planning. The aim of discharge planning is to reduce hospital length of stay and unplanned readmission to hospital, and to improve the co-ordination of services following discharge from … Sometimes separate, conflicting plans may be developed, for example, if a patient is transferred to a series of wards after admission. 3. Simple discharge can be executed at ward level with the multidisciplinary team. 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. 10. Discharge planning has been identified Junior doctors have an important role to play in planning a patient’s discharge form hospital #### Summary points Discharge planning is a process that aims to improve the coordination of services after discharge from hospital by considering the patient’s needs in the community. Funding issues, change of residence or increased care needs that need to be negotiated between health and social care make discharge complex. This area of practice has proved extremely difficult to implement and embed within NHS organisational philosophy. 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. The high impact actions have made nurse led discharge a key deliverable (NHS Institute for Innovation and Improvement, 2009). • Be honest with your providers in the type/kind of discharge support you need. As with any health policy, Ready to Go? ... 2010). It is often a challenge to know where to start implementing a new policy. Use a discharge checklist 24-48 hours before transfer. 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. Provided that the clinical management This is where nurse led discharge should come to the fore to support an array of existing measures aimed at reducing overall length of stay and promoting seven day working patterns (Webber-Maybank and Luton, 2009; Lees, 2007). Start planning for discharge or transfer before or on admission. These steps are applicable to all patients including patients with diabetes. To ensure effective and efficient discharge practice, clinical staff and managers have to understand the interactive dynamics of new terminology, new services and new process steps not only in the context of their clinical area but also across the hospital and community. The aim of this step is to identify the likely patient pathway from or before admission. For example, adding to the process may be acceptable but missing elements from it will delay discharges. For example, in general therapists only work Monday to Friday, which means that the therapy plans in place must continue on a weekend with nursing staff support. Plan discharges and transfers to take place over seven days to deliver continuity of care for the patient. Principle 1: Plan for discharge from the start. This “step up/step down” community bed based services. The impact of discharge planning on mortality, health outcomes, and cost remains uncertain 42. The discharge process must work efficiently out of hours and must not add to delays caused by lack of transport, medications and so on. The high impact actions for nursing and midwifery (NHS Institute for Innovation and Improvement, 2009) are also crucial, incorporating a standard that focuses on discharge, entitled “ready to go – no delays”. 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 guidance describes nine key steps in effective discharge and transfer of care that can facilitate faster, safer discharges for patients (see graphic). Discharge planning for specific … 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. 1.2 National/local context and evidence base The commissioning intentions set out in this specification have been informed by the NHS Dorset Strategic Plan for a Healthier Dorset 2010- 2014 which set out the key priorities for health care in Dorset. Make decisions to discharge and transfer patients each day. Members of the multidisciplinary team need to act as advocates to enable patients to make choices, and must have the skills and knowledge to navigate through available and appropriate services with patients (Birmingham, 2009). Ideally, only one plan should be central to the discharge process; this will avoid confusion and duplication of documentation, and should ensure transparency. The new blended learning nursing degree at the University of Huddersfield offers…, Please remember that the submission of any material is governed by our, EMAP Publishing Limited Company number 7880758 (England & Wales) Registered address: 7th Floor, Vantage London, Great West Road, Brentford, United Kingdom, TW8 9AG, We use cookies to personalize and improve your experience on our site. 9. 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