The Discharge Strategy Handbook

Creating Capacity by Eliminating End-of-Stay Delays

Highly relevant
High international relevance: The material in this study applies to acute care providers around the world.

By reading this study, you will learn how to: ensure discharge date prediction, forecast post-acute needs and destination, coordinate end-of-stay process, and leverage post-acute capacity to avoid delays.

Executive Summary

The efficiency imperative

Under pressure to provide high-value care to rapidly growing patient volumes, hospitals must create virtual capacity by reducing average length-of-stay. Despite government and media focus on the hospital's front door, improving discharge efficiency is the most powerful way to create this capacity: when patients who are medically fit linger in beds, other hospital efficiency improvements suffer.

Creating capacity by eliminating end-of-stay delays

Most hospitals take a reactive approach to patient discharge, postponing tasks until patients are medically ready to leave. Clinical staff understandably prioritise clinical care tasks over discharge tasks, and capacity shortages and poor relationships between acute and post-acute providers make securing post-acute care services difficult. This exacerbates discharge delays. These tandem challenges create a sense of futility among clinicians and hospital leaders, and many accept discharge delays as inevitable.

Clinical Operations Board members can check out the appendix for examples of risk scoring, discharge planning tools, and more.

5 ways to avoid discharge delays

1. Ensuring discharge date prediction

To make effective discharge plans, set a goal: a predicted date of discharge that the whole care team, patients, and families can work towards. Hospital leaders must embed accountability for early date prediction into hospital workflow.

2. Forecasting post-acute needs and destination

Planning post-acute care for patients who require it is the next essential step. This requires input from numerous stakeholders—doctors, nurses, clinicians, patients and families—early in the patient stay, while targeting limited assessment and planning resources only to patient with complex discharge needs.

3. Installing proactive preparation for discharge

With an effective planning process in place, organisations must implement changes that ensure proactive execution of discharge plans. To realise this goal, hospitals will need to build an infrastructure that embeds discharge tasks into daily care routines.

4. Coordinating end of stay process

Not all discharge tasks can be completed in advance, so hospitals must develop processes to identify and prioritise, last-minute, essential tasks by shifting responsibility to staff with free capacity.

5. Leveraging post-acute capacity to avoid delays

Finally, hospitals must act to avoid delays due to external providers, by developing collaborative relationships with sub-acute and primary care or by independently managing new capacity.