Abstract
Introduction: Discharging patients from hospital is a complex process which requires multiple professions and processes. Late afternoon discharges can lead to admission bottlenecks and contribute to emergency department overcrowding. Focusing on discharging patients earlier in the day, can contribute to greater flow through the hospital and greater patient satisfaction. Leeds Teaching Hospital Trust (LTHT) aims to achieve 70% of discharges before 3pm. The Specialist and Integrated Medicine (SIM) department care for frail elderly patients who are at increased risk of harm following prolonged stays in the emergency department and were discharging 30% of patients before 3pm.
Method: To gain greater understanding, a survey was conducted amongst various staff members to understand their perceptions of why delays occur in patient discharge. A deep dive into discharges after 3pm was also conducted to identify avoidable delays. This enabled multicomponent interventions to be developed with the team and enacted across SIM. These included:
- Education about the importance of timely discharge
- Community discharges prioritised in pharmacy the day before
- 'Golden patient' identified on wards for morning discharge.
- Promoting utilisation of the discharge lounge
- Recognition of achievement for wards
- Recruiting of junior doctors to lead individualised ward QI projects to improve earlier discharge
- Involvement of senior leaders to have buy in from consultants and senior managers
- Discharge boards being utilised.
Results: SIM achieved a 12% improvement in number of discharges before 3pm which has been sustained despite increasing pressures on the department. This is the highest median ever achieved by the department.
Conclusion: Achieving patient discharges earlier in the day is complex and requires a multifocal approach from multidisciplinary professionals. The interventions used were based on an in depth look at data and developing an understanding of the perceived and actual barriers from the team themselves.