title: Estimating date of discharge at ward level: a pilot study.
abstract: BACKGROUND
  Reimbursement is part of the government's strategy to reduce the level of delayed patient discharge from hospital. This article describes a pilot study, undertaken on one ward in a large NHS teaching trust, to involve clinicians in estimating a date of discharge for patients, to improve discharge practice and assist the reimbursement process. Since January 2004, if a patient is not fit for discharge within a day of being designated for discharge, social services has to reimburse the acute trust up to 120 pounds sterling per day for the delay, if the reasons for the delay were attributed to a delay in the provision of service. The barriers to implementing this initiative at ward level are discussed and suggestions made for a pragmatic way forward to enable a process for estimating a date of discharge to work in practice.
  
  
  CONCLUSIONS
  Estimating a date for discharge requires two fundamental steps: a clinical process to estimate and/or document a date of predicted medical fitness, followed by a communication process to document an estimated date of discharge. Effective discharge planning leading to a reduction in delayed discharges will not occur without these two steps.
authors.affiliation: Birmingham Heartlands and Solihull NHS Trust, Bordesley Green. Liz.lees@heartsol.wmids.nhs.uk
authors.forename: Liz
authors.initials: L
authors.lastname: Lees
authors.forename: Catherine
authors.initials: C
authors.lastname: Holmes
mesh_terms: D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D005544:Forecasting; D006742:Hospital Bed Capacity; D006757:Hospital Units / Q000458:organization & administration; D006784:Hospitals, Teaching; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008505:Medical Staff, Hospital / Q000523:psychology; D020380:Needs Assessment / Q000458:organization & administration*; D024802:Nurse's Role; D009730:Nursing Assessment / Q000458:organization & administration; D015403:Nursing Evaluation Research; D009741:Nursing Staff, Hospital / Q000523:psychology; D010347:Patient Care Planning / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D019555:Physician-Nurse Relations; D010865:Pilot Projects; D015397:Program Evaluation; D012051:Reimbursement Mechanisms / Q000458:organization & administration; D012948:Social Work Department, Hospital; D013222:State Medicine / Q000458:organization & administration