Codesigning an Improved Surgical Discharge Experience

Hospital discharge is a critical yet frequently under-optimised point in the surgical journey. In many public hospital settings, including Royal Brisbane and Women's Hospital (RBWH), preparation for discharge often begins late in the admission and relies heavily on verbal communication delivered shortly before departure. Patients are rarely educated pre-operatively about what discharge will involve, what information they will need, or how to prepare for recovery at home. As a result, discharge is experienced as an event rather than a structured process.

Once admitted to the ward, information is commonly delivered across multiple clinicians ' surgical teams, nurses, pharmacists and allied health professionals ' often in separate conversations. While clinically appropriate, this fragmentation creates duplication and inconsistency. Patients frequently report uncertainty regarding medications, wound care, activity restrictions, follow-up appointments and escalation pathways. Cognitive overload following anaesthesia, pain, sleep disruption and emotional stress further reduces information retention. Even when explanations are clear, recall is limited.

Patient Reported Experience Measures at RBWH consistently identified discharge as a low-performing domain. Patients described leaving hospital feeling underprepared, unsure who to contact and anxious about managing their recovery independently. This knowledge gap increases reliance on post-discharge phone calls, primary care visits and, in some cases, emergency department presentations.

From a hospital systems perspective, inefficient discharge processes directly affect patient flow. Delays in completing discharge documentation, clarifying instructions, arranging follow-up or resolving last-minute concerns contribute to prolonged length of stay. Bed block restricts availability for incoming elective and emergency admissions. In high-demand surgical services, delayed discharge can affect operating theatre scheduling, contribute to case cancellations and reduce overall throughput. Even small inefficiencies accumulate across weeks and months, contributing to stagnant operating capacity and growing elective surgery waitlists.

Discharge variability across wards further compounds inefficiency. Without a structured, patient-facing framework, discharge communication remains clinician-dependent. This increases repetition, administrative burden and time spent answering recurring patient queries. It also limits opportunities for shared accountability in recovery, where patients actively document and understand their instructions.

In addition to operational impact, discharge confusion poses safety risks. Incomplete understanding of medications, wound care or red-flag symptoms may delay help-seeking behaviour or result in avoidable complications. National Safety and Quality Health Service Standards emphasise communication for safety and partnering with consumers, yet practical, structured discharge tools are inconsistently embedded in ward practice.

Despite long-standing recognition of these challenges, no standardised surgical discharge guide existed within Surgical & Perioperative Services at RBWH. Information was dispersed across discharge summaries, verbal advice and fragmented documentation, with no consolidated, patient-centred framework to guide the transition home.

The central problem addressed by this initiative was:

How can surgical discharge be redesigned to reduce confusion, standardise communication and support more efficient patient flow?

By co-designing a structured, consumer-informed discharge guide, this initiative aimed to embed clarity, consistency and early preparation into the process.

This initiative succeeded because it was implemented within a clinical environment where discharge challenges were already recognised by frontline staff and consumers. Surgical wards at RBWH operate under sustained bed pressure and throughput demands, creating both urgency and receptiveness to discharge redesign. Strong clinical leadership, multidisciplinary engagement and active partnership with the RBWH Consumer Advisory Group were critical enablers. Importantly, the initiative was embedded into existing workflows and supported by a Best Practice Implementation Guide, which reduced variability and promoted shared accountability for discharge planning.

A key lesson was that discharge must be reframed as a process that begins early in admission rather than an event occurring on the day of departure. Introducing the guide at the start of the inpatient stay allowed progressive completion, reducing last-minute information overload. Standardisation improved consistency of communication and supported clearer expectations for both patients and clinicians.

Another lesson was the importance of simplicity. Patients valued structured layout, plain language and dedicated space for personalised instructions. Clinicians reported that having a consolidated resource reduced duplication and improved clarity during multidisciplinary discharge discussions. However, sustained clinician engagement remains essential; tools alone do not drive change without consistent reinforcement of best practice expectations.

Strengths of the project include genuine consumer co-design, multidisciplinary collaboration, low implementation cost and measurable patient-reported improvements in clarity and confidence. The initiative aligned closely with National Safety and Quality Health Service Standards and addressed both patient experience and system flow priorities.

Limitations include short-term evaluation during inpatient stay only and absence of formal measurement of operational metrics such as length of stay, discharge timing compliance, emergency re-presentations or readmissions. The project was implemented within a single metropolitan service, and broader evaluation across different Hospital and Health Services would strengthen generalisability. Additionally, as a paper-based tool, scalability may be limited without future digital integration.

If undertaken again, earlier involvement of digital health and informatics teams would support development of an electronic or hybrid version to enable data capture and performance monitoring. Expanded engagement with rural and culturally diverse populations would also strengthen inclusivity.

The structured discharge model has clear applicability across surgical specialties, medical wards, day surgery units and short-stay services within Queensland Health. Any service experiencing discharge variability, bed pressure or elective throughput constraints could adapt the framework.

Next steps include broader rollout across Metro North, formal evaluation of discharge timing and flow-related metrics, and exploration of digital integration within existing electronic discharge systems. This initiative demonstrates that consumer-informed standardisation of discharge can simultaneously improve patient confidence and strengthen system flow.