Claire Dawson
Hospitals are under increasing pressure to speed up patient discharge, with bed occupancy in NHS wards reaching 94% in November 2022. Strategies to improve discharge times include enhanced communication between providers, early rehabilitation, and the use of specific equipment. Patients can also take steps to speed up their discharge, such as starting discharge conversations early, having a designated point of contact, and preparing any necessary equipment for their return home. While incentives for timely discharges can motivate staff, there are concerns that they may lead to premature discharges, highlighting the importance of balancing speed with patient safety.
| Characteristics | Values |
|---|---|
| Housing support services | Housing support coordinators help with housing applications, provide wellbeing support, and refer patients to other services. |
| Early discharge implementation programs | Identifying patients who can be discharged early helps speed up the process. |
| Additional staff | More doctors, nurses, and other healthcare professionals can help reduce delays. |
| Expanded emergency departments | Increasing the number of beds and treatment spaces in emergency departments can help improve patient flow. |
| Efficient information handover | Effective communication between hospital staff and community teams ensures a smooth transition for patients being discharged. |
| Rehabilitation programs | Early rehabilitation helps prevent deterioration and reduces the need for further treatment before discharge. |
| Equipment availability | Sufficient equipment is necessary to continue care plans after hospitalization. |
| Carer involvement | Involving carers in discharge planning and decision-making can reduce the risk of patients returning to the hospital. |
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What You'll Learn
Housing support services
Housing support coordinators (HSCs) are integral to these services, providing specialist support to hospital inpatients with housing needs. HSCs work diligently to assist patients with any housing-related matters, empowering them to leave the hospital confidently. They undertake tasks such as locating appropriate housing, facilitating referrals to other services, and participating in multidisciplinary discharge planning meetings.
The University of Sheffield evaluated the impact of HSC services between January 2020 and March 2022. The research revealed that HSCs effectively reduced discharge delays, improved patient outcomes, and enhanced the hospital discharge process for those with complex housing issues. Patients benefited from the assurance that their housing concerns were being proactively addressed, while healthcare staff gained more time to focus on front-line clinical work.
In the UK, a notable example of HSC integration is found in the collaboration between Wakefield District Housing (WDH), a prominent social housing provider, and two NHS hospital trusts: a mental health hospital and an acute hospital. This initiative aimed to facilitate timely discharges by addressing housing issues. HSCs in this context were experienced housing officers who provided support for various determinants of tenancy sustainability, including health and financial aspects.
To further support individuals in need of housing, hospital discharge staff can leverage resources such as the Common Housing Application for Massachusetts Programs (CHAMP) and the Section 8 Housing Choice Voucher Program. These programs facilitate access to subsidized and affordable housing options, respectively, contributing to the overall housing support ecosystem.
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Early discharge implementation programs
One successful early discharge program is the SWIFT initiative at Lyell McEwin Hospital in South Australia. SWIFT, a team of doctors, nurses, and allied health professionals, utilizes Artificial Intelligence software to identify patients ready for discharge swiftly. This has resulted in a significant decrease in ramping, with a 45% improvement over five consecutive months. Additionally, the program has expanded the ambulance patient offload zone, increasing the number of offload beds available, thereby streamlining patient admission and triage processes.
Another effective strategy is the integration of housing support services within hospitals. Housing Support Coordinators work with patients to address housing-related needs, ensuring they have appropriate housing or social care post-discharge. This proactive approach prevents housing issues from escalating and reduces the "revolving door" of hospital readmissions. It also improves patient outcomes and frees up time for healthcare staff to focus on clinical work.
Furthermore, early discharge programs can include patient educational interventions, multi-disciplinary clinical management programs, rehabilitation interventions, and pharmacological care. For instance, the Home Hospitalization/Early Discharge program provides acute and chronic patients with in-home care, daily home visits by specialized nurses, and complementary tests. This program has demonstrated high satisfaction rates, reduced readmission rates, and significant cost savings compared to conventional hospitalization.
Lastly, the GEDI program at the Lyell McEwin Hospital focuses on supporting older patients with multiple chronic conditions. By offering specialist assessments and screening, the GEDI team, including geriatricians and nurses, determines if patients require hospital admission or can be cared for through community-based services. This initiative has successfully avoided unnecessary hospital admissions for 50% of the participants.
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Increasing hospital beds
Increasing hospital bed capacity is a complex issue, especially in the wake of the pandemic, which has caused bed occupancy to reach an all-time high. Hospitals need to increase physical inpatient capacity to manage the expected influx of patients. Here are some strategies to increase hospital beds:
Firstly, hospitals should ensure that beds are only allocated to patients who absolutely need them. This can be achieved by expanding medical clinic hours and improving outpatient services, so patients with acute or chronic conditions can be treated before their condition deteriorates and requires inpatient care.
Secondly, hospitals can increase bed capacity by converting spaces such as rehab and psych specialty beds into acute patient rooms. They can also utilise "flat spaces" such as lobbies and waiting rooms, as these can provide an additional 10% capacity. Additionally, hospitals can set up temporary field hospitals or use community spaces like vacant buildings, hotels, or convention centers to isolate patients who test positive for infectious diseases but do not require hospitalisation.
Furthermore, hospitals should focus on streamlining and expediting patient discharge. This can be achieved by implementing effective seating programs and reablement programs to help patients recover and get back on their feet quickly, reducing the length of their hospital stay.
Lastly, hospitals can work with local post-acute care facilities to accelerate the discharge of lower-acuity patients, preserving inpatient capacity for those who require it. This approach has been successfully implemented in various hospitals, resulting in a significant increase in weekend discharges and a reduction in ramping hours.
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Reducing bed-blocking
Housing Support Services
Local authorities, housing, and health services can work together to address housing insecurity and prevent the "revolving door" of hospital readmissions. For example, the NHS and local authorities in the UK have trialled employing housing support coordinators to help patients with housing applications, provide wellbeing support, and refer them to other services. This not only improves patient outcomes but also frees up time for healthcare staff to focus on clinical work.
Streamlining Discharge Processes
Hospitals can implement initiatives to streamline the discharge process and reduce delays. For example, hospitals can set target discharge times, such as 11 am, to encourage problem-solving and teamwork among staff. Additionally, hospitals can utilise technology, such as artificial intelligence software, to identify patients who can be reviewed for discharge, saving clinicians time.
Early Discharge Implementation Programs
Hospitals can identify patients who can be discharged early, allowing hospitalists to focus on discharging these patients as soon as possible. For instance, the overnight admitting team can determine if patients who come to the ER can be sent home the next day, allowing hospitalists to round on them first thing in the morning.
Rehabilitation and Reablement Programs
Patients who undergo surgery or experience deterioration in their condition during their hospital stay may require rehabilitation or reablement programs to get them back on their feet. Early intervention with these programs can prevent further complications and the need for extended treatment, expediting the patient's discharge.
Involving Carers and Community Services
Involving carers and community services in the discharge process is crucial to ensuring a smooth transition for patients leaving the hospital. Hospitals should facilitate the involvement of unpaid carers, such as family members, in the discharge process and the creation of a discharge plan. Information about the patient should be handed over to relevant community teams to ensure a continuous and informed care plan.
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Effective rehabilitation
Firstly, early initiation of rehabilitation is crucial. Patients who undergo surgery or experience deterioration in their functional abilities during hospitalisation require prompt reablement programs. These programs aim to enhance patients' mobility, balance, muscle tone, and overall independence, reducing the likelihood of complications that may delay discharge.
Secondly, integrating housing support services within hospitals can significantly reduce discharge delays. Housing Support Coordinators assist patients with housing applications, provide wellbeing support, and make referrals to relevant services. This proactive approach prevents housing issues from escalating and contributes to improved patient outcomes and reduced hospital readmissions.
Additionally, efficient discharge planning is essential. Hospitals should ensure seamless information handover to relevant community teams, enabling the development of informed care plans. This includes involving unpaid carers, such as family members, in the discharge process to ensure continuity of care and meet patients' needs effectively.
Furthermore, hospitals can implement initiatives to streamline the discharge process. For example, identifying patients who can be discharged early allows social workers and case managers to initiate discharge planning ahead of time. Setting discharge target times can also enhance teamwork and problem-solving, improving patient satisfaction and bed management.
Lastly, the involvement of additional clinicians can expedite discharges. The SWIFT initiative, for instance, has successfully reduced discharge backlogs by deploying a dedicated team of doctors, nurses, and allied health professionals to review patients for discharge using Artificial Intelligence software. This approach has increased weekend discharges and improved patient flow in emergency departments.
By implementing these strategies, hospitals can enhance the effectiveness of rehabilitation, improve patient outcomes, and speed up discharge processes, ultimately alleviating pressure on inpatient wards and emergency services.
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Frequently asked questions
There are several things you can do to speed up your discharge from hospital. Firstly, start preparing before you plan on leaving. Have the conversation about discharge on your first day. If possible, have one friend or family member handle your discharge information. Make sure you understand your injury or illness, and the next steps to take.
Hospitals can improve communication among providers by using an electronic medical record (EMR) system. Hospitals can also set target discharge times, which encourages problem-solving and teamwork. Hospitals should also ensure that patients are ready for discharge, with appropriate equipment and care plans in place.
Strategies include using visual boards to coordinate staff, identifying key metrics, and standardising the discharge process. Hospitals can also identify patients who can be discharged early, and work towards achieving this.
Speeding up hospital discharge helps to free up beds for new patients, reducing waiting times and pressure on emergency services. It can also help to control costs and improve patient satisfaction.
