On 21 August 2020, HM Government issued a new hospital discharge policy 'Hospital Discharge Service: Policy and Operating Model', which replaced the original guidance issued on 19 March 2020. This discharge policy is for patients aged 18+.
The policy outlines new ‘Criteria to Reside’ (this can be found on page 39 of the policy document) in an acute hospital bed, with which every patient should be reviewed on a twice daily basis. Once patients no longer meet the Criteria to Reside, they will not be able to remain in hospital if they choose not to accept the care that is being offered to them. Where they may need ongoing care but do not need to be an inpatient, they will be allocated services in the community. In some cases, it may be that patients are first moved to an intermediary setting, before a more long term plan is set out. The majority of patients should be going home with any necessary support (Home First).
- Twice daily Board rounds with daily senior review before 10am prioritising the sickest patients followed by the patients to be discharged. At each board round, patients should be assessed against the Criteria to Reside. Please note that the terms ‘medically fit’ or ‘back to baseline’ should not be used, in line with the Government Policy as this has been replaced by the Criteria to Reside.
- eWhiteboards should be updated in real time with:
- Accurate PDD’s assessed against the criteria to reside (clinically fit to leave the acute hospital bed). All patients must have a discharge pathway (0-3) identified and logged on EPR within 14 hours of admission.
- Pathways (level of support required on discharge). These pathways are in line with the Government Policy.
- Discharge Date Confirmed (DDC) – This indicates all patients due to be discharged and services have been confirmed as in place.
- Discharge delay reasons identified if the patients no longer meet the Criteria to Reside.
- Clinical Criteria for Discharge (CCD) - this is the minimum physiological, therapeutic and functional status the patient needs to achieve before discharge against the criteria to reside
- Clinical actions – the tasks that need to be completed to progress the patient towards discharge.
Single Referral Process:
When a patient no longer meets the criteria to reside in hospital and requires care services, their care needs should be detailed on the Single Assessment Tool (SAT) so that ongoing care can be identified and arrangements made. These should be emailed to the Complex Discharge Team (CDT), who will submit them to the Single Point of Access (SPA) as a request for services.
The SPA will inform the ward what care has been allocated and when the discharge can go ahead.
Timeframes:
Patients who no longer meet the criteria to Reside in hospital will be expected to be prepared for discharge by the wards immediately.
Pathway 0 patients should be leaving the ward within 1 hour of decision to discharge.
Pathways 1-3 should aim for discharge within 24 hours of decision to discharge.
Funding is being made available and we are working with our partners to broker additional bed based intermediate placements and packages of care.
Funding can also be made available for equipment and adaptations if needed. It is really important that financial decisions do not slow down or get in the way of discharges, so please escalate any problems you have.
Patients are being informed when they are admitted to hospital of the changes, and national leaflets have been produced for patients who are being admitted, and those who are being discharged.
Patients who are due to be discharged from our trust with ongoing care at home or in a residential setting need to be swabbed for COVID-19 prior to discharge.
Once a confirmed date has been set, arrange for a swab to be taken less than 48 hours before discharge. Swabs should be labelled as pre-discharge test.
