Make decisions to discharge and transfer patients each day. Sign in or Register a new account to join the discussion. This study is a 3-staged process to develop, pretest and pilot a framework for an effective discharge planning system in Hong Kong. The 10 steps set out the essential steps in discharge and transfer planning, supported by 10 operating principles. Although it will never replace the role of the multidisciplinary ment of Health outlines 10 key steps to improve discharge (DH, 2010b), one of which describes using nurse or midwife-led discharge (Box 1). 6. Review the clinical management plan with the patient each day, take any necessary action and update progress towards the discharge or transfer date. The pace of discharge and transfer is such that most clinical areas have developed systems where they have a dedicated coordinator. A discharge‐checklist tool was created to facilitate safe discharge from hospital.RESULTSThe final checklist describes the processes necessary for a safe and optimal discharge and recommended timeline of when to complete each step, starting from the first day of admission. required for effective discharge planning and transfer from the acute hospital setting (see figure 1). Start planning for discharge or transfer before or on admission. Discharge checklists have proven to be a difficult area of practice to sustain. Clinicians who are involved in discharge planning should explore the following issues in the redesign of processes to speed up patient discharge and transfer: Table 1 gives practical tips on implementing each step. Planning the Discharge and the Transfer of Patients from Hospital and Intermediate Care – should leave nurses in no doubt that the scope of discharge practice has evolved significantly. The aim of this step is to identify the likely patient pathway from or before admission. Liz Lees, MSc, BSc, DipHSM, DipN, RGN, is consultant nurse, acute medicine, Heart of England Foundation Trust, Birmingham. Department of Health Publication year: 2010 ... organisational review and audit; and seven-day-a-week proactive discharge planning. Personalised care and support planning is a process in which the person with a long-term condition is an active and equal partner. 7. 2. The table below details 10 key steps to safe and timely discharge (*adapted from: Ready to go, DH 2010). In elective care, planning should begin before admission. The National Integrated Care Guidance begins by outlining and explaining the nine key steps required for effective discharge planning and transfer from the acute hospital setting (see figure 1). Simple discharge (inpatient or day case) 1. The steps are based on good practice previously identified, used and evaluated by service providers in the HSE Integrated Discharge Planning Code of Practice (2008) and incorporate the key lessons Order Essence of Care 2010 online from the TSO Bookshop; To order by telephone: Please call +44 (0)870 243 0123 Textphone +44 (0)870 243 3701. Funding issues, change of residence or increased care needs that need to be negotiated between health and social care make discharge complex. It is often a challenge to know where to start implementing a new policy. The 10 Steps – „Ready to Go‟ (DH 2010) 23 Appendix B Extract from report, ‘Strategy for Improving Integration of Care Pathways to support discharge from hospital’, presented to the Discharge from Hospital Review meeting on 30/5/13 24 & 25 . Integrated Discharge Planning Documents. This review gives an introduction to, and taster of, our newly launched Nursing Times Learning unit on discharge planning The key principles of effective discharge planning discharge plaNNiNg learNiNg objecTives This learning unit is free to subscribers and £10 + VAT to non-subcribers at Steps 8 and 10 are inextricably linked but looking at them separately means we can consider two different perspectives – organisational processes required to instigate appropriate availability of seven day services and the clinical infrastructure needed to include senior clinical decision makers across a spectrum of care (Royal College of Physicians, 2007). Clinical management plans do not have to be prescriptive – they should serve as a guide and be revisited if/when patients move through the continuum of care (Lees and Delpino, 2007). Strategically – to predict overall hospital capacity; Operationally – to assess progress and outcomes of clinical plans; Individually – for patients to understand the expectations, limitations and engagement required from them in the process of planning discharge (Lees and Holmes, 2005; DH, 2004). 10 key steps to safe and timely discharge. For simple discharges carried out at ward level, the process should be standardised throughout an entire hospital. Information exchange and collaboration between care providers are essential, but deficits are common. Why plan ahead: how you and your family, friends and carers can benefit from planning ahead for your future care. Step 2: Discuss the pros and cons of discharge to a skilled nursing home versus home and any other issues specific to your situation with the hospital discharge planner. Equally, it is important not to overlook the elements of the existing process, as it is vital to understand the obstacles that staff might face on a daily basis; this is the key to the new process being sustainable. Discharge planning is a care process that aims to secure the transfer of care for the patient at transition from home to the hospital and back home. The aim is not to replicate information but to ensure that vital aspects of planning are not missed amid the increased activity before discharge. Background: Discharge planning is a routine feature of health systems in many countries. ... 2010). Discharge planning is complicated, particularly in those who are frail, elderly or have complex care needs. Keywords Discharge planning, Transfer, Patient involvement, Delayed discharge. Essentially, the expected date of discharge is estimated and is intended as a guide for the discharge planning process. Members of the multidisciplinary team need to act as advocates to enable patients to make choices, and must have the skills and knowledge to navigate through available and appropriate services with patients (Birmingham, 2009). Discharge planning involves a coordinated effort between the patient/resident, caregiving professionals, family members, and community supports. This is where the greatest improvement could be made in the whole process of setting an estimated date of discharge. • Be honest with your providers in the type/kind of discharge support you need. These steps include identifying whether the person has simple or complex discharge needs, setting an expected date of discharge/ transfer and reviewing treatment plan with the person on a daily basis. To order via TSO shops and official agents: 4.4 Action steps 40 4.5 Practical examples 40 4.6 References 42 Appendices 4.1 Carer’s assessment checklist 43 4.2 Carer’s assessment and care plan 44 4.3 Patient’s and carer’s leaflet 45 Contents. Coordinate the discharge or transfer of care process through effective leadership and handover of responsibilities at ward level. Final Reminders for Discharge Planning Advocates in the Home Health Care Setting. 9. use a discharge checklist 24-48 hours before transfer. Make decisions to discharge and transfer patients each day. Ten steps set out the essential processes in discharge and transfer planning and are supported by 10 operating principles. Although the 10 steps are not prescriptive, they should all be considered to prevent a collapse of the entire system. 10. carers and the communities they live in, their needs, aspirations, values and their definition of quality of life. 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