An audit and staff survey, about discharges from our hospice inpatient unit, highlighted areas for improvement; delayed discharges, lack of training and delayed discharge letters. It also showed a lack of understanding around discharge procedures among staff and therefore confidence at moving the process forward. The authors devised a discharge pathway that includes sections for doctors, nurses, physiotherapists, occupational therapists, social workers and carers. The sections contain comprehensive instructions for each role, to ensure we are considering all aspects of the patient's needs. It also helps staff understand what is required of them in the discharge process. The section for carers was created after consultation with a hospice carer support group and produced because the authors wanted to make sure the authors were meeting their needs as well.
A separate pathway is being used for rapid discharges, to account for the different circumstances of such discharges. Within both pathways is a sheet that includes important contact numbers. This is given to the patient on discharge and can be used by the patient, carer or health professional, for information about who is involved in care and provides the preferred priority of care. To improve the length of time it takes to send a discharge letter out, the authors are typing instead of dictating them. The whole process has given us the opportunity to train all our staff, on the discharge process, when the authors implemented it. The discharge pathway has improved staff understanding and confidence in the discharge procedure and therefore our discharges are more robust. The authors still have delayed discharges, but the reasons for these are often out of our control; mainly due to equipment delivery. The discharge pathway now comprehensively covers the needs of a patient being discharged from a hospice inpatient unit, who potentially has unstable disease and therefore needs regular support.
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