An Examination of Policies Underpinning Implementation of Criteria Led Discharge: Scoping Review Protocol

Objective: The objective of this scoping review is to evaluate the extent and type of global policies,
guidance, toolkits and protocols in relation to criteria led discharge (CLD).
Introduction: CLD enables selective patient discharges to be delegated to non-medical healthcare
practitioners through clinical criteria, determined by a senior medical decision maker (usually but
not exclusively a consultant). CLD is a patient discharge improvement initiative that can accelerate
the discharge process and contribute to freeing bed capacity earlier in the day. However, evidence-
based research into the effectiveness of CLD remains limited and implementation has been termed
variable and inconsistent.
This scoping review aims to systematically identify and map the grey literature [specifically policies
and procedures] which describe CLD implementation processes, to explore prerequisite human
behaviours for implementation from policy to practitioner level. This research will inform future
implementation studies and policy development for CLD.
Inclusion criteria: The review will focus on policies, procedures, guidance, toolkits and protocols as
well as other non-research evidence relating to implementation of CLD. The participants will be adult
(>18 years) patients being discharged with the concept of exploring the process of patient discharge
from hospital into the community where healthcare practitioners as part of a team follow clinical
criteria determined by a lead medical clinician. The scope will be within acute state funded hospitals
within developed countries, such as National Health Service (NHS) in the UK. Non-research evidence
detailing children, maternity or community settings will be included but described separately to
consider all relevant evidence.
Methods and analysis: Non-research evidence and grey literature will be obtained from systematic
searches of Google, Google Scholar, grey literature databases and other grey sources to obtain policy
and process documents, guidelines, pathways, toolkits and other online media. The search strategy,
including all identified keywords and MeSH index terms, will be adapted for each included data
source and/or database and will be designed alongside a healthcare science librarian. The reference
lists of all included sources will of evidence will be screened for additional literature. Evidence
published in English only will be included via a targeted search from January 2014 to January 2024.
The proposed scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI)
methodology (Peters et al. 2020). Two independent reviewers will conduct screening and full text
review. Data extraction will be conducted by one reviewer and a proportion verified by another.
End-user collaboration will occur throughout the scoping review, with engagement from the NHS
Emergency Care Improvement Support Team (ECIST) and subject experts. Findings will be
synthesised and reported via a narrative summary to accompany the tabulated and/or charted
results. This will describe how the results relate to the reviews objective and question/s in
accordance with JBI methodology (Peters et al. 2020)
Ethics and Dissemination: Research ethics review via Coventry University (as per student process)
will be sought, although this is a review of secondary data, from previously published policies. The
results of this review will be published in a manuscript and with the intention to be presented at
national and potentially international patient discharge and flow conferences.
Registration: This scoping review protocol is registered in Open Science Framework