Patient care - daily dynamic discharge approach: guidance

Delay in a Patient's Journey

Inevitable or Preventable?

There are many things which have the potential to cause delay and unnecessarily prolong a patient's stay in hospital, some of which can be categorised as 'external' (services or resources external to the ward or hospital which may not be available when the patient needs them). However, there are also internal causes of non-clinical delay, and these equally contribute to poor patient experience; for those patients in a bed, waiting for what they need and for those waiting to access the bed.

Evidence from the Day of Care Audits ^[2] carried out across NHSScotland indicates that at any one time, between 20% and 40% of patients in hospital beds no longer require acute care but their transfer to another area for continuing care, or discharge to General Practitioner has been delayed.

The complexity of the discharge planning process; the way the plan is communicated and the choices made in the way the plan is executed, can lead to what appears to be inevitable delays for patients during their stay. For most, the human response to the many conflicting demands on their time is to locally optimise and work in a way which may be best for them as individuals (or in a way that may seem most logical for someone who works across wards), but which may not support the optimal flow of patients. In fact this 'mis-synchronisation' of the Multi-Disciplinary Team ( MDT) often causes delay, and this can add significantly to a patient's length of stay.

Extended length of stay and discharge patterns which are more in line with how wards and individuals tend to work than the patient's needs, wreak chaos every day in hospitals everywhere.

Balancing the day's clinical and care delivery needs, with the timely completion of tasks required to ensure timely discharge is an ever-present challenge for ward teams. Staff constantly juggle doing what's best to support patient flow and making the best use of often scarce resources.

This guidance seeks to define a framework and provide guiding principles to help better manage this balance, supporting the safe and timely transfer of patient care out of hospital, and thereby also improving the timeliness of access to treatment.