Policies, Procedures and Guidelines for Criteria-led Discharge: A Scoping Review

<sub>Introduction: Criteria Led Discharge (CLD) enables the delegation of selective patient
discharges to to non-medical registered healthcare practitioners through clinical criteria,
determined by a senior medical decision maker1. CLD can contribute to freeing bed capacity
earlier in the day2
. However, evidence-based research into the effectiveness of CLD remains
limited and implementation has been termed variable and inconsistent3,4
.
This scoping review focuses of international policies, procedures and guidelines relating to CLD
within acute hospitals aimed to describe CLD implementation processes and to explore
prerequisite human behaviours for implementation from policy to practitioner level.
Methods: Searches of publicly available regional, national and international documents on CLD
was undertaken from grey literature databases, Google and websites, plus calls for evidence. A
methodological framework from Joanna Briggs Institute was adapted5
.
The search strategy included all identified keywords, and was adapted for each data source.
Evidence published in English only was sought via a targeted search from January 2014 to April
2024. Two independent reviewers conducted screening. End-user collaboration was used
throughout the scoping review process with engagement from the NHS Emergency Care
Improvement Support Team and subject experts.
Results: 20 documents (6 countries) provided policies, guidelines, guidance, protocols,
procedures and toolkits. Twelve included reference to the evidence base but the extent to which
it was used varied. Six documents presented the process stages of CLD but didn’t document
implementation processes. Only 2 focused solely on implementation with just one referencing
behaviour related to CLD implementation. The remainder using directive terminology but lacked
specificity in actions required.
Conclusion: This review demonstrates evidence-based rationale and implementation processes
and behaviours, is sporadic. Given the heterogeneity in purpose and scope of these documents,
detailed information on implementation processes is limited. This review will inform future
implementation studies and recommendations for CLD policy development.
REFERENCES
1. NHS England. (2022). Rapid improvement guide to criteria-led discharge .
https://transform.england.nhs.uk/improvement/100-day-discharge-challenge/ten-best-practice-
initiatives/supporting-information/rapid-improvement-guide-to-criteria-led-discharge/
2. Lees-Deutsch, L., & Robinson, J. (2019). A Systematic Review of Criteria-Led Patient Discharge.
Journal of Nursing Care Quality , 34 (2), 121–126.
https://doi.org/10.1097/NCQ.0000000000000356
3. NHS England, & NHS Improvement. (2021). Improvement guidance for writing a criteria-led
discharge policy . Generic . https://www.england.nhs.uk/wp-content/uploads/2021/10/B0928-
criteria-led-discharge-guidance-v2.pdf
4. Brangwin, Emma, & ECIST. (2023). December ECIST meeting: CLD menti feedback.
5. Peters, M. D. J., Marnie, C., Tricco, A. C., Pollock, D., Munn, Z., Alexander, L., McInerney, P.,
Godfrey, C. M., & Khalil, H. (2020). Updated methodological guidance for the conduct of scoping
reviews. JBI Evidence Synthesis , 18 (10), 2119–2126. https://doi.org/10.11124/JBIES-20-00167
PRESENTED BY
Mrs. Emma Brangwin
Coventry University - (⚑ United Kingdom)
AUTHORS
1.
Mrs. Emma Brangwin (⚑ United Kingdom) 1
2.
Dr. Agnieszka Lewko (⚑ United Kingdom) 1
3.
Prof. Liz Lees-Deutsch (⚑ United Kingdom) 1
1. Coventry University
LEAD PRESENTER BIOGRAPHY
Emma is a Doctoral Student completing her PhD with Coventry University in the Midlands, UK.
She remains employed by UHCW NHS Trust as a physiotherapist and works clinically within
Orthopaedics one day a week.
The aim of the PhD is to explore the ‘elephants in the room’ surrounding CLD implementation
and will seek to understand the necessary motivators required to change the behaviour of
healthcare professionals, doctors and managers in order to increase engagement with a
complex intervention such as CLD. This would be done using proven implementation science
theory such as Michie’s ‘Behaviour Change Wheel’.
TOPICS
Clinical topic, research field and research issues: Service innovation and improvement
Research approach: Systematic review or other secondary research
Data collection or analysis method: Other collection or analysis method</sub>