Aim The Children’s Hospital Discharge Collaborative (CHDC) team are a multi-disciplinary group of staff members passionate about improving the quality and efficiency of our discharges. The aim of this project is to increase the number of patients being discharged within working hours in order to facilitate a safe return to routine for families, improve patient flow within the hospital and ultimately improve patient experience.
Method As a collaborative we have trialled interventions in ward areas, learnt what works and what needs improvement, all of which has enabled us to roll out evidence based changes throughout the Children’s Hospital. We have held monthly meetings and received good engagement from ward areas and a broad range of specialties which has meant that we have collaborated and shared ideas. The CHDC team have utilised existing morning huddles to identify potential discharges as early in the day as possible, or even the day before, as well as communicating this by the use of a discharge board visible to all staff members meaning that this information is readily available. We also challenged existing norms, and empowered leadership from within ward areas to drive projects. We have encouraged the early preparation - sometimes overnight - of quality discharges using a new acronym for electronic discharge advice notes (eDANs - Easy to read, Drugs, Advice, Next Steps). We have facilitated nurse-led and criteria led discharges as well as increased our safe use of over-labelled discharge packs. Another quality improvement project piloted the process of finalising the discharge medicines before the clinical information was completed enabling earlier dispensing.
Results In the period from October 2020 to July 2021 the median percentage of weekly discharges before 1500hours has risen from 36% to 49%. In patient terms, this means approximately 18-20 more patients per week being discharged home before 1500hours.
Conclusion and Future Aspirations The CHDC team have increased discharges before 1500hours across the Children’s Hospital by 13% over the last 9 months by working collaboratively and enthusiastically to rethink the existing processes used. This also equates to 1 or 2 wards full of patient space that is free for the next family that needs it. We hope to continue this good work and improve on this further by collecting some qualitative data from families to explore their thoughts about the discharge process.
The Trust is now investigating a re-design of the eDAN process to enable a change in discharge process across specialties, meaning that the whole Trust could benefit from this project’s initial work. The CHDC team also plan to continue to collaborate and celebrate our achievements, both locally and nationally by completing positive feedback forms, issuing certificates and ‘Discharge Champion’ badges and sharing our learning by presenting our work.
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