Problem
Criteria led discharge (CLD) is a process where patients can be discharged from the ward by competent multidisciplinary staff (for example, nursing, allied health, or junior doctors), based on documented clinical criteria set by senior medical clinician of the team. The aim of CLD is to Improved patient and staff experience, communication between patients and staff and amongst multidisciplinary team; and improved efficiency on the discharge process. Prior to the practice change implementation, there was no process where appropriate patients can be identified for nurse- led CLD from the ward. It is recognised that early discharge of appropriately identified patients from the ward can improve bed flow in the hospital (Lees-Deutsch & Robinson; 2019).
Design
The audit was conducted in January 2023, in a geriatric ward with 29 inpatient beds, allocated for acute care of the elderly and delirium care unit.
Practice change
A Criteria Led Discharge (CLD) form was implemented. This allowed senior medical clinicians to identify appropriate patients, following agreement in the multidisciplinary meeting, who can be discharged by a nurse if the criteria in the CLD form were met.
Re-audit
There was a total of 86 discharges from the ward during the audit period. Nineteen (22%) of the discharges were identified as CLD. Of the CLD, majority of the patients were discharged home (57.9%), followed by other hospital and TCP/RCF (21.1% each). There were patients who were CLD on all days of the week, except Sunday. Prevalence of dementia (63.2%) and delirium (73.7%) diagnoses was significant in patients identified for CLD. The discharge diagnosis of delirium accounted for 36.8% of CLD patients. Under half (47.4%) of patients identified for CLD was able to be discharged before 10am from the ward. Majority of patient identified of CLD who were not able to be discharged before 10am were due to delay in transport.
Conclusion
Nurse-led CLD is a feasible initiative in an acute geriatric ward. Older patients with delirium and dementia can be appropriately identified for CLD with support by senior clinician, plus agreement by the multidisciplinary team together with the patient and their next of kins. CLD can be useful in assisting patient flow in hospital. Further interventions looking at increasing uptake of CLD and addressing potential delays in discharge are being explored.