Background Review of discharge processes was identified as a workstream within an overall in-patient unit project modernising ways of working to meet current service demands. Staff feedback showed increasing anxiety relating to completion of the discharge process and documentation, in particular relating to continuing health care funding. Anecdotally it was also felt that patient and family expectations of ongoing hospice care were a barrier to timely discharge planning.

Aims

1. Increase in number of patient discharges

2. Reduction in length of stay

3. Increase staff understanding of discharge processes

4. Produce patient information leaflet.

Method A senior staff nurse led the work stream and undertook a retrospective base line audit of patient discharges and a staff survey to explore their experience of discharging patients from the in-patient unit (IPU). Using these results a patient leaflet has been produced, clearly outlining hospice expectations, discharge details and funding streams.A part- time discharge educator, with extensive experience of continuing health care, has been employed to review discharge processes and provide staff education. Education has been delivered one-to- one in relation to patient discharges in real time and within a formal setting.

Results Audit results have shown that the uncertainty of end of life care, family concerns and timely access to nursing home placements and care packages are significant factors when planning discharge from the IPU. It was also identified that clinical pressures affected timely completion of discharge documentation.

Achievements at six months:

• Increased patient discharges

• Reduction in average length of stay to 14 days

• All qualified staff have received training and awareness training for nursing assistants planned

• Patient leaflet completed.

Conclusion Patient flow and staff confidence have increased significantly following commencement of the project and the discharge educator post has been extended for an additional six months.