Central Adelaide
Local Health Network
Criteria Led Discharge
and it’s place in Multidisciplinary
Discharge Planning
Criteria Led Discharge (CLD)
Criteria led discharge provides an option for
addressing timely discharge by equipping
clinicians aside from a Medical Officer with the
necessary knowledge, skills and experience to
review patients and initiate discharge in line with
criteria, policies and procedures which have a
multi-disciplinary agreement.
We are CENTRAL
CLD ensures that a patient discharge may occur
when defined criteria are met. If the patient does
not meet the criteria, then the CLD process is
abandoned. This means that clinical staff may
discharge a patient without waiting for a routine
medical review as long as certain predetermined
criteria have been documented and met.
We are CENTRAL
Benefits of CLD
To actively reduce the delays experienced by
patients due to difficulty obtaining individual
medical decisions when being discharged from
hospital
To provide a model that facilitates timely
discharge for patients
To empower frontline clinical staff to provide timely
discharge for patients and the organisation
To ensure high quality and consistency of
discharge management practices
Improve patient flow
Reduce length of stay
We are CENTRAL
Timely communication with patients / families /
carers – avoiding unexpected late / unplanned
discharges
Timely communication between health care
professionals
Provide a smooth discharge process over 7 days
Assist medical staff workload (and provide some
structure in duties)
Admit the emergency or elective patient earlier
therefore beginning treatment earlier
Assist meet hospital wide targets
We are CENTRAL
Development of Criteria Led
Discharge in Central Adelaide LHN
Background
Criteria Led Discharge (Event Led Discharge) was
first trialled in 2007 within units at the Royal
Adelaide Hospital
In 2009, SA Health released the Criteria Led
Discharge policy directive
Targeted projects since at both the Royal Adelaide
and The Queen Elizabeth Hospital with little
sustainability
Differing models exist within 23 hour units across
our sites
We have not been able to sustain any of the
models to date
In 2013, 6 Central Adelaide clinicians participated
and graduated with Joanna Briggs Institute (JBI)
Fellowship specifically designed for research and
implementation of CLD
Central Adelaide have developed a toolkit for staff
to utilise when developing and implementing a
CLD
Central Adelaide have aligned their procedural
guidelines to the SA Health directive
Joanna Briggs Institute
Is the international not for profit research and
development arm of the School of Translational
Science based within the Faculty of Health
Sciences at the University of Adelaide. It aims to
provide the best available evidence to inform clinical
decision making at the point of care.
JBI Clinical Fellowship Program
Significant investment of clinician time: 22 weeks in
total
Stage 1- intensive week long training residency
The conduct of a clinical audit in the Fellow’s own
practice site
Stage 2 –further week long intensive training
residency
JBI staff remained in contact throughout
Presentation and graduation of findings of Clinical
Fellows CLD projects
Barriers we need to overcome
Incentive and buy in for staff to implement
How do we measure the impact
Streamlining the discharge communication,
practice and process
Consideration with EPAS roll out
Confidence of nursing staff to lead
Target the right patient group / pathway
Developing a consistent process as part of
orientation and the communication strategy
Having the model as a ‘opt out’ not ‘opt in’
Criteria Led Discharge in
The Queen Elizabeth Hospital
Medical Directorate
Aim
For discharge planning to commence on
admission by a multi-disciplinary team
That discharge should be non complex
That discharge practices should align with best
patient care
To identify and effect change across discharge
practices
To improve capacity management and capability
within the hospitals through reducing length of
stay and improved use of resources
To collaborate and improve relationships with a
medical team that is supportive of CLD
Ward South One Experience
Progress Ward South One
Intermittent use of CLD by General Medicine team
Plans to explore making CLD an ‘opt out’ model for
all discharges
Progress has slowed due to the lead of the CLD
project for the Medical Directorate leaving TQEH
The model has been discussed in other units for
implementation e.g. cardiology, endocrine and
gastroenterology teams
Criteria Led Discharge in the Acute
Medical Unit at
The Queen Elizabeth Hospital
CLD application in the AMU
AMU was invited to participate in a Clinical
Redesign project using Lean Thinking principles
AMU mapped current processes and confirmed that
the patient exit from the hospital continues to be a
barrier to meeting admission targets
AMU and the Medical Directorate decided to target
the communication and discharge practices during
the patient journey – which included
implementation of CLD
Background
Current discharge practices were not timely or in
line with the SA Health suggested AMU Model Of
Care i.e. 48hrs (TQEH AMU was developed with a
72hr LOS target before the guidelines were
developed)
Inconsistent communication by Multi-D team
Increased LOS for the non-AMU patient outlied in
AMU
Pt not receiving R) care at R) time in R) place
Multiple outliers i.e. at times 3 AMU patients in
AMU and 15 AMU in outlied wards as AMU has
other clinical units patients
No Criteria Led Discharge (CLD)
Getting the message across
We were not re-inventing the wheel (utilising the
General Medicine CLD)
CLD is not a new strategy
We have strong support from our Consultant
underpinning the success of the implementation of
CLD on the AMU
Education sessions provided to all AMU medical
officers, nursing staff and allied health staff prior to
implementation
Close monitoring is on-going
Counter Measure Activities to
support CLD
To support interdisciplinary communication
regarding CLD we developed a discharge huddle at
our patient journey board each day at 3pm with the
senior nurse for the afternoon shift, the RMO,
Pharmacist and ward clerk
Communication strategies
Simple Standard Operating Procedure developed
and distributed to all staff
Communication strategies
CLD Format
A generic form was
developed for use
across all medical
patients (same model
that was
implemented in 2007
– adjusted to clinical
specifics)
Early results Average discharge time decreased slightly since
huddles and other discharge strategies
implemented i.e. average time previous was
1416hrs (variable) but since huddle consistently
going down (taken about 30 mins off discharge
time)
Comparison of discharge 11
targets
July 2013 to December 2013 25 AMU patients
discharged by 11am
January 2014 to June 2014 53 patients discharged
by 11am (Clinical Redesign strategies implemented
which included CLD)
Early success
Discharge medications / scripts done day before
discharge
Transport organised earlier
Discharge process more organised and
coordinated
Huddle – letter done on OACIS day prior to
discharge (nursing and medical)
Approximately 20 patients discharged via CLD
over last 4 months
Improved Multi-D communication
Ward South1 at TQEH interested in implementing
the 1500hr discharge huddle where CLD can be
discussed
Value added to patient care and
staff morale
More streamlined discharge process
Patients and staff communicate about discharge
process earlier
Less complaints from patients and families about
lack of discharge communication
Pharmacy education is provided the day prior to
discharge
Improved Multi-D approach to patient care
New patients pulled from the emergency
department earlier and treatment regimes
beginning earlier
Medical staff ‘feel safe’ that the nursing
staff won’t discharge patients that are
outside of the established parameters
Value added to patient care
and staff morale
Where to from here…..
Sustainability
To be driven by a team of staff or system approach
- until this point all our attempts have been driven
by individuals and when they leave - the process
generally leaves too
Communication is vital in ‘selling the message’
about the benefits of CLD and it’s contribution in
addressing patient flow, capacity management,
patient satisfaction and staff workload balance
It is not only about CLD in isolation - discharge
discussions need to happen daily even if CLD is
not an option for each patient
‘Talk like a team for the discharge stream’
Questions?
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