title: Facilitating terminal discharge: fulfilling the hospitalised patient's wish for home death in the final hours.
abstract: BACKGROUND
  Terminal discharge (TD) is the rapid discharge of a hospitalised patient when death is imminent. Its time-limited nature makes it challenging, particularly for ward nurses.
  
  
  OBJECTIVE
  To report the development of a structured TD framework, and determine if the framework can expedite TD processes and improve nurses' experience in conducting TDs.
  
  
  METHODS
  A 3-phase audit was carried out in a Singapore hospital. The baseline and post intervention audits evaluated the time taken for TD, incidence of prescription errors, continuity of care, and timeliness of equipment arrangement. Nurse satisfaction was assessed through a written survey. Interventions encompassed the implementation of workflow changes and a TD guide.
  
  
  RESULTS
  The mean time taken to complete TDs was shorter in the post-compared to pre-intervention phase (2.9±1.4 vs. 4.6±2.3 hours respectively, p<0.01). Approximately 89% of nurses who used the TD guide were satisfied that it made TDs easier.
  
  
  CONCLUSIONS
  A structured TD framework is effective in expediting TDs and improving nurse satisfaction.
authors.affiliation: Assistant Nurse Clinician, Division of Palliative Medicine, National Cancer Centre Singapore (NCCS), Singapore.
authors.forename: Yung Ying
authors.initials: YY
authors.lastname: Tan
authors.affiliation: Senior Nurse Clinician, Advance Practice Nurse, Division of Palliative Medicine, NCCS, Singapore.
authors.forename: Zhi Zhen
authors.initials: ZZ
authors.lastname: Xu
authors.affiliation: Senior Manager, Home First Group, Agency for Integrated Care, Singapore.
authors.forename: Grace Sy
authors.initials: GS
authors.lastname: Pang
authors.affiliation: Senior Research Coordinator, Division of Palliative Medicine, NCCS, Singapore.
authors.forename: Limin
authors.initials: L
authors.lastname: Qu
authors.affiliation: Nurse Clinician, Department of Nursing, Singapore General Hospital, Singapore.
authors.forename: Yi
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Nurse Clinician, Department of Nursing, Singapore General Hospital, Singapore.
authors.forename: Ai Min
authors.initials: AM
authors.lastname: Zhang
authors.affiliation: Senior Consultant, Division of Palliative Medicine, NCCS, Singapore.
authors.forename: Patricia Sh
authors.initials: PS
authors.lastname: Neo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D057189:Checklist; D003266:Continuity of Patient Care; D003643:Death; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D008875:Middle Aged; D009726:Nurses; D009741:Nursing Staff, Hospital; D010351:Patient Discharge; D057240:Patient Preference; D012846:Singapore; D013727:Terminal Care / Q000379:methods*; D062606:Tertiary Care Centers; D013997:Time Factors; D057188:Workflow
keywords: End of life; Patient discharge; Rapid discharge; Terminal care