The clarity of the 10 steps enables specific areas of the discharge process to be audited in order to create a focus for where work needs to be undertaken on specific points in the pathway. This review gives an introduction to, and taster of, our newly launched Nursing Times Learning unit on discharge planning The key principles of effective discharge planning discharge plaNNiNg learNiNg objecTives This learning unit is free to subscribers and £10 + VAT to non-subcribers at The plan should include a brief analysis of local health and social care services available to support people who are discharged from hospital. 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. It may also prevent some failed discharges and help patients and healthcare professionals understand/set expectations. 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. Background: Discharge planning is a routine feature of health systems in many countries. This article examines the current policy context surrounding discharge in the health service, and gives practical advice on implementing the 10 steps. ‘If you read one thing today, make sure it’s Vicky Neville’s open letter’, 28 June, 2010 Department of Health Publisher: Great Britain. Clinicians who are involved in discharge planning should explore the following issues in the redesign of processes to speed up patient discharge and transfer: Table 1 gives practical tips on implementing each step. 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. Advance decision to refuse treatment: if you do not want certain kinds of treatment in the future, you can make a legally binding advance decision. Use a discharge checklist 24-48 hours before transfer. 3.3 Whole system working for effective hospital discharge 18 3.4 The contents, characteristics and components of a good inter-agency discharge policy 19 3.5 Action steps 22 3.6 Practical example 22 3.7 References 22 Appendices 3.1 Supporting the system 23 3.2 Transport 29 3.3 Discharge planning self-assessment tool 32 4. 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). 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. Effective discharge has also been a priority area in Australia since 1998. • Be honest with your providers in the type/kind of discharge support you need. Early discharge planning. 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. 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. Further supportive materials and examples of good practice are available from the linked website. Although it will never replace the role of the multidisciplinary Personalised care and support planning is a process in which the person with a long-term condition is an active and equal partner. For simple discharges carried out at ward level, the process should be standardised throughout an entire hospital. 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. The key messages are: check it out, ask the patient and make it happen. 8. For example, adding to the process may be acceptable but missing elements from it will delay discharges. seven-day-a-week proactive discharge planning. The steps are based on good practice previously identified, used and evaluated by service providers Keywords Discharge planning, Transfer, Patient involvement, Delayed discharge. A wide range of initiatives to improve the discharge planning process have been developed and implemented for the past three decades. 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). • Start with small, manageable steps toward planning for discharge such as setting weekly goals to review … 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. Discharge checklists have proven to be a difficult area of practice to sustain. Background: Discharge planning is a routine feature of health systems in many countries. Lees L (2010) Exploring the principles of best practice discharge to ensure patient involvement. ... 2010). 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. Discharge planning is complicated, particularly in those who are frail, elderly or have complex care needs. • Take steps to understand both the perspectives of the patient and their . In some areas with early supported discharge schemes, Saturday working is becoming more commonplace. Make decisions to discharge and transfer patients each day. Which of the 10 steps may be missing in their discharge process; Where implementation might fail through lack of support or where it has already failed; Where there may be resistance to any of the 10 steps. This document focuses specifically on aspects of diabetes care that should be considered at discharge . Discharge planning is a routine feature of health systems in many countries. úëÉÁ#fP¨:x�íUU¿ÙÁ¡ßŒr©4ƒk( i¿>ئ� >é/É)å¢í²!¹Â. Source: department of Health (2010) Box 1. 6. Review the clinical management plan with the patient each day, take any necessary action and update progress towards the discharge or transfer date. This study is a 3-staged process to develop, pretest and pilot a framework for an effective discharge planning system in Hong Kong. a significant reduction in length of stay for inpatients; the development of a sustainable and scalable approach that could be used trust-wide. These steps are applicable to all patients including patients with diabetes. 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. A brief overview of the 10 key principles of effective discharge planning from a nursing perspective. To order via TSO shops and official agents: Plan the date and time of discharge early For each step the Lean methodology has been used. Funding issues, change of residence or increased care needs that need to be negotiated between health and social care make discharge complex. The table below details 10 key steps to safe and timely discharge (*adapted from: Ready to go, DH 2010). 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. According to the NHS Institute for Innovation and Improvement, Lean is an improvement approach to improve flow and eliminate waste, developed by Toyota. 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. The 10 steps of discharge planning. 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:. Ten steps set out the essential processes in discharge and transfer planning and are supported by 10 operating principles. Sometimes separate, conflicting plans may be developed, for example, if a patient is transferred to a series of wards after admission. 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). Review, action, progress (RAP) is the process that has been suggested for this (NLIAH, 2008). Furthermore, a whole new vocabulary on patient discharge and transfer has developed, such as “capacity”, “flow”, “predictability” and “breaches”. 1.2.1. 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