Discharge without Delay

Getting patients home effectively

What’s it all about?

In DME, we pride ourselves on planning and coordinating safe discharges home for our patients. It’s a team effort and there are several strands to doing this well:

• We are introducing the Huddle Script – a structured way of conducting the morning ward handovers. We focus on; any patient deaths, which patients are going home and have we got everything ready for the discharge, which patients are unwell and require a priority review.

• Every ward runs Multi-Disciplinary Team Meetings (MDTM) to discuss patient progress and what needs done to get the patient home as soon as possible.
• We use the principles of Home First. This means that we aim to return patients to their original homes rather than keep them in hospital to pursue alternative care like nursing homes. This relies on close working with our social work and community rehabilitation colleagues – involving them early in discharge planning and family discussions.
• We set a Planned Discharge Date (PDD) for every patient, this used to be called the Estimated Discharge Date or EDD. We set the PDD at the MDTM and update at the morning Huddle Script handover, to ensure it is accurate.
• We aim to set out what’s needed to achieve the PDD (the Criteria Lead Discharge, CLD).
• We promote patient activity; Get Up, Get Dressed, Get Active. Deconditioning occurs very quickly in older adults if they remain in bed. We need to counter this.

Hospital Flow?

The pressure on our hospitals has been immense over recent months. Beds are at a premium. We know that discharging patients home in the mornings, creates space for the Emergency Department and Receiving wards to empty into. In turn, patients get admitted without waiting for long times in ambulances and on trolleys. Patients are deliberately moved out of ED and the Receiving units from 09.00hrs to our wards – the GlasFLOW model. Sometimes this means that wards have an ‘extra’ patient until a bed can be cleared. Hence, this reinforces the need to plan and discharge patients efficiently and before noon.

What can you do?

You can greatly help your patients get home by helping in a few key areas:

• Be the patient’s advocate – speak up for what’s important to them. Avoid paternalism.
• Help promote the setting of PDD and CLD at the Huddle Script handovers and MDTM – speak up and ask about them.
• Help update PDD on Trakcare – see below on how to do this.
• Getting the Immediate Discharge Letter (IDL) done the day before discharge / first thing that morning, really makes a difference. Our patients are then able to get home before noon.

Please prioritise IDLs therefore.

• If you see a new patient and think they may get home over the weekend, put them out for a Weekend Discharge Review – use Trak handovers to communicate this need.

Thank you – simple things makes a huge difference!