Estimating date of discharge at ward level: a pilot study.

BACKGROUND

Reimbursement is part of the government's strategy to reduce the level of delayed patient discharge from hospital. This article describes a pilot study, undertaken on one ward in a large NHS teaching trust, to involve clinicians in estimating a date of discharge for patients, to improve discharge practice and assist the reimbursement process. Since January 2004, if a patient is not fit for discharge within a day of being designated for discharge, social services has to reimburse the acute trust up to 120 pounds sterling per day for the delay, if the reasons for the delay were attributed to a delay in the provision of service. The barriers to implementing this initiative at ward level are discussed and suggestions made for a pragmatic way forward to enable a process for estimating a date of discharge to work in practice.

CONCLUSION

Estimating a date for discharge requires two fundamental steps: a clinical process to estimate and/or document a date of predicted medical fitness, followed by a communication process to document an estimated date of discharge. Effective discharge planning leading to a reduction in delayed discharges will not occur without these two steps.