Criteria Led Discharge: What are the benefits and impacts? A Report Summarising the Insights of Two Organisations Engage in CLD in the Midlands Region to Further Adoption and Spread

Executive Summary

Criterial Led Discharge (CLD) is a process where the multidisciplinary team can enable patients to be discharged from hospital at the right time. This review follows the development of a point prevalence survey tool called Selecting Patients for Efficient and Effective Discharge (SPEED). This was developed by colleagues at the Centre for Care Excellence, Coventry with further detailed tool developments, as well as scale and spread, undertaken in close collaboration with, and led by, the NHS Midlands Nursing Team. The tool was created to provide evidence of the opportunity for development of CLD through large scale data collection. CLD has since been implemented to varying degrees across the Midlands.

This review seeks to capture the learning from two organisations that have successfully implemented CLD, to identify the potential benefits for patients, for staff, for organisations and the health and care system. By capturing and reporting these experiences and analysing the available data, this report outlines the potential impact of CLD.

This report also intends to provide a valuable resource to inspire the wider adoption and spread of CLD and outline opportunities for measuring these benefits as well identifying some key enabling activities that contribute to the success of CLD in practice.

The review:
• Looked at metric data from regional and organisational dashboards.
• Undertook a workshop with two trusts and colleagues at Centre for Care Excellence, Coventry University, and NHS Midlands, to capture their experiences.
• Summarised the learning into this this report aiming to further the adoption of CLD in the Midlands.

Review of data on CLD

Review of the routinely collected performance data, for example the Urgent and Emergency Care and discharge measures as well as local Trust data, demonstrated that these data are often not sensitive enough to identify the extent of impact. Trusts were able to use additional local data to demonstrate the extent of implementation and impact for patients.

Benefits identified

A benefits workshop approach captured a number of benefits as well as the changes required to deliver these benefits. These were grouped into three areas of CLD implementation – clinical systems, clinical teams and the clinical processes.

The key benefits identified included:
• For patients
• Patients are better informed about their discharge plan.
• Patients go home earlier in the day.
• For staff:
• Increased professional competency and extended scope.
• Not having to seek or wait for a response from others in the MDT, saving time and effort.
• Increased trust and better MDT working.
• For organisations / health and care system:
• Process improvements e.g. patients being discharged at a more convenient time of day, reduced movement of patients to a different ward for non-clinical reasons (‘outlying’).
• Improved flow, enabling patients to move through their journey more quickly.

Additional benefits are also outlined, as are a number of pre-requisites enabling activities.

Sustaining CLD

While both Trusts highlighted significant success on adopting CLD, both outlined opportunities to both embed and expand the practice. The benefits discussion outlined a number of practical challenges they have faced, and the workshop captured the team’s advice for others adoption CLD. Key factors identified include strong professional relationships and trust. The workshop identified key insight into:

• The conditions for embedding and sustaining CLD at a local/ward level.
• Aspects of team stability, trust and collaboration.
• The need for well-developed and skilled workforce.
• Leadership and standardised practices.
• CLD as an indicator of high-quality care and positive impact on patient/carer experience.

The discussion also highlighted opportunities around including CLD into accreditation process and the shared professional decision-making model of leadership.

Taking CLD forward

The report makes several suggestions to support the further adoption and spread of CLD. It provides suggestions for how organisations may approach the measurement of CLD, whilst being careful not to make recommendations on what should be measured, and instead suggests considerations that teams implementing CLD could consider when defining measures, drawing on process and outcome measures, as well as practical factors such as effort and value. These considerations are framed within three areas: operational, staff/workforce and patient impacts.

Recommendations for adoption and sustainability are made in the following areas:
• Pre-implementation engagement.
• Assessing readiness to adopt.
• Articulating the benefits of CLD to stakeholders.
• Processes and including CLD into Electronic Patient Record systems.
• Maintaining and sustaining CLD including, celebrating CLD, sharing impacts with teams and establishing the role of CLD champion/CLD lead practitioner.




Conclusion

This work has identified that CLD provides an opportunity to not only improve the experience of discharge for patients, but also has many benefits, including to patient flow across the hospital. It also identified benefits for members of the MDT in terms of better working practices and professional development.

It is recognised that CLD is complex, requires changes in the way people work across professional groups and requires both leadership and skilled, confident CLD practitioners.

The review makes a number of valuable suggestions to help more patients, more practitioners and all organisations benefits more widely from this key practice.