Development a Point Prevalence Survey Tool to Determine the Opportunities and Characteristics of Patients Suitable for Criteria Led Discharge from Hospital: A Multi-Site Feasibility Study

Introduction: The introduction of Criteria Led Discharge (CLD) provides an opportunity to improve patient flow, through specific clinical parameters for patients, which aid clinician decision making to bring the time of patient discharge earlier in the day1. Despite national guidance2 and success in some settings,3 the implementation of CLD has a limited evidence base. This study describes the development of a point prevalence patient survey (PPS) tool to characterise the potential opportunities and characteristics of patients suitable for CLD.

We hypothesised this survey would;- enable the engagement of multidisciplinary staff; demonstrate the opportunities for CLD development and, cultivate large scale data of the patient characteristics.

Methods: Mixed Methods comprised a point prevalence survey; feasibility testing methodology and co-design. Feasibility was guided by eight developmental phases namely: acceptability, demand, practicality, implementation, adaptation, integration, efficacy, and expansion. User testing enabled feedback for survey tool reiterations. Categorical data were analysed descriptively. Change theory using COM-B, was employed to analyse the elements Capability, Opportunity, Motivation and subsequent Behaviours.

Results: We developed a PPS tool which illuminated the potential opportunities and characteristics of patients potentially suitable for a CLD. This study stimulated multidisciplinary team engagement in the tool at pace and scale across 22 organisations, (32 hospital wards) to provide data during May and October 2022. This is the first multi-organisational, multidisciplinary collaboration to confirm the opportunities for CLD (over 50% of patients surveyed) which warrant development of clinical criteria to support patient discharge in pathways [0 and 1].

Discussion: Participation was motivated from multidisciplinary staff and improved understanding of the scale of opportunities and issues which inhibit CLD. Staff indicated that the PPS tool provided an acceptable and quantifiable approach to collect data, which could challenge patient discharge scenarios. It provides multidisciplinary evidence to consider the suitability of patient characteristics for a criteria led discharge.

MeSH Terms: Patient Discharge; Patient Selection; Prevalence.

Ethics:

R&D: GFREC-0482 (April 2022).

References:

1Lees-Deutsch, L., Balaji, A., Jackson, J., A Topping. (2019) Developing a process for Criteria Led Patient Discharge Selection of Patients for Efficient and Effective Discharge (SPEED). Journal of Nursing Care Quality, DOI: 1097/NCQ000000000000423

2National Health Service England (2021) National Guidance for Introducing Criteria Led Discharge–version 2 (PAR928) https://www.england.nhs.uk/wp-content/uploads/2021/10/B0928-criteria-led-discharge-guidance-v2.pdf [last accessed 08/06/2023]

3Findlay C. Fong G, Goldie, S et al (2023) Implementing criteria-led discharge for acute admissions to facilitate the elective recovery from Covid-19: an example in acute tonsillitis. BMJ Open Quality 12:e002123. DOI: 10.1136/bmjoq-2022