Criteria Led Discharge (CLD) refers to the discharge of patients by nursing, midwife, allied health and junior medical staff who have the necessary knowledge, skills and competencies to review patients and initiate inpatient discharge. The process is supported by predetermined criteria which are developed with multi-disciplinary agreement and approved by the Authorised Admitting Practitioner (consultant or other) who has the ultimate clinical responsibility for the patient.
Criteria Led Discharge
Summary
Aim
The discharge of patients can be hindered by system as well as patient factors. Use of CLD ensures that patients are discharged as soon as is clinically and socially safe / appropriate to do so. Use of CLD supports re-engineering of system processes if required to facilitate efficient discharge practice.
Benefits
- increased patient and carer satisfaction
- reduced length of stay
- improved patient flow through inpatient facilities
- improved multidisciplinary discharge planning and practice
- improved healthcare cost efficiency
- improved access to hospital beds
- improved achievement of National Emergency Access Targets and National Elective Surgery Targets
- transparent discharge practices
- improved bed management
- improved coordination of patient care
- reduced unplanned re-admissions related to the initial reason for admission.
Background
Queensland Health is committed to the delivery of high quality, safe, best practice and cost effective health care. In February 2013, Queensland Health implemented the Blueprint for better healthcare in Queensland. This document prioritises CLD as a primary patient flow strategy. While there are many components that contribute to effective bed utilisation, implementation of appropriate discharge processes is key to facilitating optimal patient flow. The use of CLD facilitates effective discharge practice by enabling clinicians, aside from Medical Specialists, with the necessary knowledge, skills and experience to review patients and initiate discharge in line with criteria, policies and procedures which have multi-disciplinary agreement.
Solutions Implemented
In addition to being an integral part of treatment planning, CLD is a patient flow process designed to streamline patient discharge to achieve:
- more efficient / timely discharge practices including decreased discharge delays
- increased numbers of discharges that occur prior to new patients arriving
- improved multidisciplinary discharge planning
- improved access to hospital beds
CLD encompasses the use of any or all of the following to effect patient discharge:
- predetermined discharge criteria
- estimated Date of Discharge (EDD)
- electronic Patient Journey Boards
- patient Flow Manager (information system software for use with Electronic Patient Journey Boards)
- discharge / transit lounges
- various models of care
- local changes to work practices
- this list is representational of strategies and tools used to support CLD but are not exhaustive.
Evaluation and Results
Performance indicators include:
- percentages of discharges that occur before 12.00pm
- percentages of discharges that occur during the weekend
- length of stay data
- for services using Patient Flow Manager, the percentages of patients considered for and then actually discharged via CLD (two separate measures)
- qualitative indicators such as patient / carer and staff satisfaction with discharge and patient flow practice.