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Publication - Guidance

The Daily Dynamic Discharge Approach Guidance Document

Published: 20 Jun 2016
ISBN:
9781786522986

The Daily Dynamic Discharge Approach - Improving the timeliness and quality of patient care by planning and synchronising the day’s activities. This document aims to help readers and potential implementers understand some of the ‘man-made’ causes of delay

30 page PDF

1.2MB

30 page PDF

1.2MB

Contents
The Daily Dynamic Discharge Approach Guidance Document
Creating a Plan

30 page PDF

1.2MB

Creating a Plan

1. Dynamic MDT Planning

The Multi-Disciplinary Team get together within 12 hours of a patient's admission and develop an understanding of the component parts of a patient's discharge plan - what treatment is required, with what - and for how long. They also consider what other things need to be done in parallel with the clinical treatment, in order for each patient to be discharged safely onto the next appropriate area of care.

Identifying what are the dependant tasks and agreeing when they each need to start (and finish) to ensure the patient can be discharged without delay is essential.

The term 'dynamic' relates to the movable nature of the estimated discharge date, and the dependant tasks relative to the patient's recovery rate.

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2s. Setting and Reviewing an Estimated Date of Discharge (EDD)

The estimated date of discharge ( EDD) is the date when the MDT believes the patient can be safely discharged from the acute hospital setting. This may be to home or another place of care.

The key to setting an accurate EDD is:

1. a clinical process to estimate and document a date of predicted medical fitness (i.e. when the patient no longer needs medical treatment in hospital)

2. followed by a communication process to document an estimated date of discharge based on the holistic/ MDT view

3. changed to reflect the most recent view of the patient's recovery rate (is this still the date we expect this patient to be well enough to leave our care?)

Figure 1 below shows an example from a hospital site of the process established to ensure consistency in setting an EDD across all wards to ensure full compliance with the Daily Dynamic Discharge approach.

Figure 1: an example from an NHSScotland Hospital site

Guidance

Electives

  • For elective admissions, the EDD is set by the admitting nurse when clerking in the patient
  • Some common conditions have typical EDDs, e.g. Troponin 1 day, UTI/Delirium 5-7 days, angioplasty 1 day, graph 5-7 days, amputation 3-4 weeks (sometimes the same procedure is performed differently by surgeons ( EDD can be between 1-5 days)

Emergencies

  • For patients admitted from the receiving unit, an initial EDD of 2-3 days is usually set

Admission

  • The admission nurse on the specialty ward completes the admission paperwork and, depending on their level of experience and the level of information available about the patient's presenting condition, will set the EDD

Setting the EDD

  • On occasions, it may be the Nurse in Charge or the Ward Clerkess who sets the EDD. If the admitting nurse does not have the level of clinical experience to estimate a discharge date, the Nurse in Charge will set the EDD.
  • On occasion, the Ward Clerks may set the EDD to complete the information needed for the whiteboard

Reviewing the EDD

  • The next morning, before the 8am ward huddle, the EDDs are reviewed and the nurse leading each team will be asked about their patients' EDDs and whether they require to be changed
  • The whiteboards would be updated by nursing staff as a result

On the ward round

  • The Consultant involved in the patient's care would review the EDD at the first ward round
  • Nursing staff would then update the whiteboard
  • The EDD would then be reviewed daily and/or at subsequent ward rounds

Communication with the patient

  • Generally the patient and family are told the proposed EDD following the first Consultant review. If the patient/family are given the EDD this is done verbally and recorded in the notes

3. Effective Ward Rounds

A fundamental part of the approach is clarity around the plan for the patient's clinical treatment to ensure that all other tasks are able to commence timeously and be aligned with the date the patient is medically fit for discharge.

To ensure that the EDD is truly dynamic and reflective of the patient's treatment and recovery, the treatment plan must be clearly communicated to the multi-disciplinary team involved.

Ensuring that ward rounds are effective and that the Senior Decision Maker's treatment plan has been clearly articulated is essential to ensuring that all elements are in place for that patients care.

It is useful to test this effectiveness and identify any areas for improvement. A proforma template is recommended to be completed during discussions for each patient; ensuring the following questions around the discharge plan are answered.

  • What is it we are treating (diagnosis)?
  • What treatment are we providing?
  • For what period of time?
  • What is the remaining duration of that today?
  • What other things need to be in place for discharge?
  • Does the EDD need to be changed?
  • Does this patient need to be seen again by a consultant before discharge (suitable for criteria led discharge)?

This process of using a proforma ensures each patient's treatment plan is consistently considered and reviewed as appropriate.


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