title: Improving the quality of vascular surgical discharge planning in a hub centre.
abstract: Introduction Discharge planning improves patient outcomes, reduces hospital stay and readmission rates, and should involve a multidisciplinary team (MDT) approach. The efficacy of MDT meetings in discharge planning was examined, as well as reasons for delayed discharge among vascular surgical inpatients. Methods Dedicated weekly MDT meetings were held on the vascular ward in Royal Derby Hospital for three months. Each patient was presented to the discharge planning meeting and an expected date of discharge was decided prospectively. Patients who were discharged after this date were considered 'delayed' and reasons for delay were explored at the next meeting. Results Overall, 193 patients were included in the study. Of these, 42 patients (22%) had a delayed discharge while 29 (15%) had an early discharge. The main reasons for delay were awaiting beds (30%), social (14%) and medical (45%). In 64%, the cause for delay was avoidable. Two-thirds (67%) of all delays were >24 hours. This totalled 115 bed days, of which 67 could have been avoided. However, 32 bed days were saved by early discharge. This equates to a net loss of 35 bed days, at a net cost of £2,936 per month or £35,235 per year. The MDT meetings also improved the quality of discharge planning; the variability between expected and actual discharge dates decreased after the first month. Conclusions Discharge planning meetings help prepare for patient discharge and are most effective with multidisciplinary input. The majority of delayed discharges from hospital are preventable. The main causes are awaiting transfers, social services input and medical reasons (eg falls). There is an obvious financial incentive to improve discharge planning. The efficiency of the MDT at discharge planning improves with time and this should therefore be continued for best results.
authors.affiliation: University of Nottingham , UK.
authors.forename: C
authors.initials: C
authors.lastname: Wariyapola
authors.affiliation: University of Nottingham , UK.
authors.forename: E
authors.initials: E
authors.lastname: Littlehales
authors.affiliation: Derby Teaching Hospitals NHS Foundation Trust , UK.
authors.forename: K
authors.initials: K
authors.lastname: Abayasekara
authors.affiliation: Derby Teaching Hospitals NHS Foundation Trust , UK.
authors.forename: D
authors.initials: D
authors.lastname: Fall
authors.affiliation: Derby Teaching Hospitals NHS Foundation Trust , UK.
authors.forename: V
authors.initials: V
authors.lastname: Parker
authors.affiliation: Derby Teaching Hospitals NHS Foundation Trust , UK.
authors.forename: G
authors.initials: G
authors.lastname: Hatton
mesh_terms: D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D010348:Patient Care Team; D010351:Patient Discharge / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D011446:Prospective Studies; D014656:Vascular Surgical Procedures
keywords: Discharge planning; Hub centre; Multidisciplinary team; Spoke centre; Vascular surgery