Estimated date of discharge for surgical admission: a way forward
Anil Bagul, Duff M Bruce
Department of General Surgery, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK
Introduction: The Planned Care Improvement Programme has highlighted the importance of developing a robust framework that supports the implementation of good clinical practice in the National Health Service. An important aspect of this process is the efficient management of patient discharge. Early prediction of an estimated date of discharge (EDD) may enable a structured discharge process.
Aims: To examine how accurately clinical staff predict a date of discharge and to identify factors that may result in discrepancies between predicted and actual date.
Design: Data was collected prospectively for all admissions to a general surgical ward at the Aberdeen Royal Infirmary. Patients were allocated an EDD upon admission by the most senior medical staff on the post-admission ward round.
Assessment and analysis: Surgical wards were piloted as areas supported by operational support to achieve EDD for all patients. Wards visited showed variable results.
Results: Forty-six (44.2%) medical staff correctly predicted the discharge date. Eighteen (11.4%) patients were discharged prior and 64 (40.5%) after their EDDs; of these 64, 12 (21.8%) had multiple factors causing the delay. Measurement of improvement was assessed by the number of patients with an accurate EDD and reasons causing a delay to discharge.
Conclusion: Extra unit referrals projected most delays, indicating a need for changes in the referrals system. This study highlights some of the causes for discrepancies and areas where system changes may influence the length of hospital stay. EDD has a positive impact on length of hospital stay.
Keywords: date of discharge, hospital stay, planned care improvement, planned discharge
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