High Impact Action: Ready to go - no delays
Increase the number of patients in NHS provided care who have their discharge managed and led by a nurse or midwife where appropriate.
Extent of the problem
Simple discharges make up approximately 80% of all discharges (Lees; 2004). The Department of Health (DH 2004) states that changing the way in which discharge occurs for this large group of patients would have a major impact on patient flow and effective use of the bed capacity. This will in turn both reduce delays and improve patient experience by helping to ensure that patients are fully informed about the process for leaving hospital.
The move towards nurse led discharge has been, in part, a response to an overall shift in discharge activity brought about by shorter lengths of stay, increasing patient throughput and the increasing acuity of patients admitted to hospital. The importance of nurse led discharge has been highlighted in government plans to overhaul the NHS discharge process (Chatergee 2004).
Benefits for patients and benefits for NHS
Benefits of nurse led discharge include a more timely planned discharge for the patient with fewer delays leading to a more positive patient (and family) experience as well as a lower risk of healthcare associated infections.
The 2009 Annual Health Check, published in October 2009 by the Care Quality Commission, has revealed the proportion of hospitals failing to hit a target to reduce delayed transfers has increased by 12% in the past two years. Nearly a quarter of trusts (24%) failed to meet the required standard for delayed transfer of care, up from 21% in 2006-07 http://www.cqc.org.uk.
It is estimated that for an average patient on an NHS surgical ward it costs up to £400 per day, indicating real financial benefits to reducing length of stay (Webber-Maybank & Luton; 2009). It is estimated that a reduction in length of stay of between two and six days per patient could save NHS trusts £15.5m-£46.5m a year in total (NAO; 2000).
HIA front-line submission
The establishment of THREADS (Taunton Hospital Early Assisted Discharge Scheme) has meant that patients admitted to hospital with an exacerbation of chronic obstructive pulmonary disease (COPD) are discharged home early and cared for by a dedicated team until well. Patients are educated comprehensively about their disease and they are offered pulmonary rehabilitation. The national average length of stay in an acute bed is 6 days. THREADS reduces this to 0-3 days (60% of patients of which 25% less than 2 days) 4-7 days 33%. Over a year period taking into account all costs and the reduction in bed days resulted in a cost saving of £42,550.
Care Quality Commission (2009) Annual Health Check. Performance Ratings. Accessed via http://www.cqc.org.uk/guidanceforprofessionals/healthcare/nhsstaff/ annualhealthcheck2008/09.cfm
Chatterjee, M. (2004) Nurses to take over simple discharge. Nursing Times; 100: 35, 2.
Department of Health (2004) Achieving timely simple discharge from Hospital. A toolkit for the multidisciplinary team. Accessed via http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh /@en/documents/digitalasset/dh_4088367.pdf
Lees, L. (2004) Making nurse-led discharge work to improve patient care. Nursing Times; 100: 37, 30.
National Audit Office (2000) Hip Replacements: Getting It Right First Time. London: NAO.
Webber-Maybank, M., Luton, H. (2009) Making effective use of predicted discharge dates to reduce the length of stay in hospital. Nursing Times; 105: 15.
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