Liz Lees, MSc, BSc, DipHSM, DipN, RGN, is consultant nurse, acute medicine, Heart of England Foundation Trust, Birmingham. 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. Identify whether the patient has simple or complex discharge and transfer planning needs, involving the patient or carer in your decision. A wide range of initiatives to improve the discharge planning process have been developed and implemented for the past three decades. 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. 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. 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. Its title – Ready to Go? Ready to Go - No Delays, one of the High Impact Actions (NHS Institute for Innovation and Improvement, 2009), offers a 10-step process for planning the discharge or transfer of patients. The key messages are: Check it out, ask the patient and make it happen. The aim of this step is to identify the likely patient pathway from or before admission. • Take steps to understand both the perspectives of the patient and their . 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. Lees L (2010) Exploring the principles of best practice discharge to ensure patient involvement. 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). The discharge process must work efficiently out of hours and must not add to delays caused by lack of transport, medications and so on. It includes a ten step plan for successful discharge planning, but no literature was found that The judgment concluded that the courts have no general power to monitor the discharge of the Local Authority's functions, but that a Local Authority that failed in its duties to a child could be challenged under the Human Rights Act 1998. Planning the Discharge and the Transfer of Patients from Hospital and Intermediate Care, Living Well with Dementia: a National Dementia Strategy Implementation Plan, Joint Commissioning Framework for Dementia, Achieving Simple Timely Discharge from Hospital: A Multidisciplinary Toolkit, Code of Practice for Integrated Discharge Planning, Facilitating an effective discharge from hospital, Using post-take ward rounds to facilitate simple discharge, High Impact Actions for Nursing and Midwifery, Passing the Baton – A Practical Guide to Effective Discharge Planning, Making effective use of predicted discharge dates to reduce the length of stay in hospital, 100629Exploring the principles of best practice discharge to ensure patient involvement, Winners of the Nursing Times Workforce Awards 2020 unveiled, Don’t miss your latest monthly issue of Nursing Times, Announcing our Student Nursing Times editors for 2020-21, New blended learning nursing degree offers real flexibility, Expert nurses share their knowledge of pressure ulcers in free-to-watch videos, Matron ‘honoured’ to administer first Covid-19 vaccine in UK, Scotland’s nurses to get £500 bonus as Covid-19 ‘thank you’ payment, Tributes to Bristol nurse and mentor following death with Covid-19, PHE updates green book with chapter on new Covid-19 vaccines, Nurses faced with ‘rotten and insect-ridden’ PPE during first wave, Nurse’s cardiac arrest inspires community’s quest for defibrillators, England deputy CNO to become new RCN director for Scotland, Pay lost by striking Northern Ireland nurses to be reimbursed, Healthcare workers ‘seven times as likely to have severe Covid-19’, This content is for health professionals only, This article has been double-blind peer reviewed. 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. Sign in or Register a new account to join the discussion. Personalised care and support planning is a process in which the person with a long-term condition is an active and equal partner. New health and social care policies during 2009 were prolific, perhaps demonstrating the complexity and challenges faced by the health service and social care in developing services fit for patients with dementia while accommodating safe discharge and transfer (DH, 2009a; 2009b). The End of Life Care Strategy: Rationa Time can be translated into money and, Discharge checklists have proven to be a difficult area of practice to sustain. Discharge planning is complicated, particularly in those who are frail, elderly or have complex care needs. 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. 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. 1. Discharge planning for specific … If used appropriately, they can help to prevent complaints about the discharge process and aid compliance with the standard for discharges within the clinical negligence scheme for trusts. 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. 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. The National Integrated Care Guidance begins by outlining and explaining the nine key 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. Steps 6 and 7 depend on step 3 being in place. A plethora of outreach services (such as intravenous therapy at home) and rapid access clinics that work with acute medicine and surgical admission units also increase the pace of discharge or transfer. Discharge checklists are seen more commonly in integrated care pathways, often for surgical conditions. 9. Discharge planning has been identified 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. These steps are applicable to all patients including patients with diabetes. Few services offer adequate provision for people with dementia. suitcase. Principle 1: Plan for discharge from the start; Principle 1: Plan for discharge from the start. 3. The table below details 10 key steps to safe and timely discharge (*adapted from: Ready to go, DH 2010). 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. Many patients who are discharged from hospital will have ongoing care needs that must be met in the community. 7. 5. For example, if there is no clinical management plan, this alone may cause staff to dismiss the process and “do it their own way”. 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 … The process should normally be recorded in a personalised care and support plan: but this plan is only of value if the process has taken place effectively. Principle 1: Plan for discharge from the start. 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 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. Start planning for discharge or transfer before or on admission. It is often a challenge to know where to start implementing a new policy. Sometimes separate, conflicting plans may be developed, for example, if a patient is transferred to a series of wards after admission. 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. 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. In some areas with early supported discharge schemes, Saturday working is becoming more commonplace. The principle is to anticipate potential delays and to respond by managing those proactively. A brief overview of the 10 key principles of effective discharge planning from a nursing perspective. It may also prevent some failed discharges and help patients and healthcare professionals understand/set expectations. 12 This plan addressed organizational issues at the interface of health and social care in order to foster more co-ordinated service delivery for older people with complex needs. Set an expected date of discharge or transfer within 24-48 hours of admission and discuss with the patient or carer. If we can consider and start to conquer these problems in individual wards, policies supporting organisational safety, patient satisfaction and reduced length of stay should start to become integrated within practice. 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