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This article reports on the experiences and evaluations of piloting health and social care discharge co‐ordinators in acute and community hospital settings. Benefits were felt with regard to length of stay, bed day use, and patient and staff experience, and were particularly notable where a discharge co‐ordinator employed by the community trust was put into the acute hospital setting. The pilots have supported a redesign of hospital discharge processes across Torbay Care Trust and South Devon Healthcare NHS Foundation Trust, and provided the foundation for improved partnership working and integrated service provision.

The purpose of this paper is to demonstrate that nurse led discharge (NLD) could improve the efficiency of simple discharges from a short stay surgical ward without compromising patient safety.

A protocol for NLD was designed and implemented. Introduction of the protocol was audited and re-audited prospectively.

Introduction of the nurse led discharge protocol significantly reduced the rate of delayed discharge (p>0.001). The protocol successfully identified all patients for whom a NLD would be inappropriate and no patients discharged by the nursing team were re-admitted.

No formal measure of staff and patient satisfaction with the new protocol was performed.

The nursing team are now able to more effectively manage patient flow through the short stay surgical ward. Mismatch between demand for beds and capacity has reduced.

Patient experience has been improved by the release of time to care for our nurses and the elimination of unnecessary delay in discharge.

Formal protocol driven NLD can be a safe way of improving efficiency in patient flow. This pattern of discharge could be applied in many hospital systems.

Total hip replacement is a common and expensive procedure. Any attempt to shorten the length of hospital stay safely is desirable. Proposes a scoring system specifically designed for this patient population, to determine the optimal timing of safe discharge and post‐acute care placement. Discusses its implications for the quality of patient care.

This paper aims to explore the unintentional formation of internal functional barriers, (organisational silos) during moves towards departmental efficiency, within an acute trust, and the subsequent effects on the discharge process in elderly patients.

This paper presents some of the findings from a qualitative study examining the role of the nurse in the discharge process. Semi‐structured interviews were conducted with a purposively selected cohesive sample of 28 registered nurses, from the medical and elderly care wards in an NHS Acute Trust. The interviews were taped, transcribed and their content analysed.

The problems associated with patient discharge were frequently operational. Each part of the process was hindered, often inadvertently, by attempts on the part of individuals, departments and services to make themselves efficient, without regard for the resulting organisational consequences. This left the ward nurses attempting to overcome the obstacles in an attempt to effectively discharge patients, within a required period of time.

It is recognised that, the perceptions of those not participating in the study may have been different to those who did participate. As a small study in one trust the results may not be generalisable.

It is imperative that evaluation of operational changes is undertaken, with particular regard to the consequences of change, for other services, patients and clients.

This type of study can provide a method of diagnosing organisational problems, especially in areas that are reliant on inter‐professional and departmental collaboration

Capture, consumption and use of person-centred information presents challenges for hospitals when operating within the scope of limited resources and the push for organisational routines and efficiencies. This paper explores these challenges for patients with Acute Coronary Syndrome (ACS) and the examination of information that supports successful hospital discharge. It aims to determine how the likelihood of readmission may be prevented through the capturing of rich, person-specific information during in-patient care to improve the process for discharge to home.

The authors combine four research data collection and analysis techniques: one, an analysis of the patient record; two, semi-structured longitudinal interviews; three, an analysis of the patient's journey using process mining to provide analytics about the discharge process, and four, a focus group with nurses to validate and confirm our findings.

The authors’ contribution is to show that information systems which support discharge need to consider models focused on individual patient stressors. The authors find that current discharge information capture does not provide the required person-centred information to support a successful discharge. Data indicate that rich, detailed information about the person acquired through additional nursing assessments are required to complement data provided about the patient's journey in order to support the patients’ post-discharge recovery at home.

Prior research has focused on information collection constrained by pre-determined limitations and barriers of system design. This work has not considered the information provided by multiple sources during the whole patient journey as a mechanism to reshape the discharge process to become more person-centred. Using a novel combination of research techniques and theory, the authors have shown that patient information collected through multiple channels across the patient care journey may significantly extend the quality of patient care beyond hospital discharge. Although not assessed in this study, rich, person-centred discharge information may also decrease the likelihood of patient readmission.

Building the Right Support, a national plan for people with intellectual disabilities (ID) in England aims to avoid lengthy stays in hospital for such people. Discharge planning is understood to be helpful in facilitating successful transition from hospital to community services, however, there is little guidance available to help those working with detained patients with ID and offending histories to consider how to affect safe and effective discharges. The paper aims to discuss these issues.

In this paper, the development and implementation of a multi-faceted and systemic approach to discharge preparation and planning is described. The impact of this intervention on a range of outcomes was assessed and the views of stakeholders on the process were sought.

Initial outcome data provide support for the effectiveness of this intervention in terms of increased rates of discharge, reduced lengths of stay and low readmission rates. Stakeholders viewed the intervention as positive and beneficial in achieving timely discharge and effective post-discharge support.

People with ID are more likely to be detained in hospital and spend more time in hospital following admission. A planned, coordinated and well managed approach to discharge planning can be helpful in facilitating timely and successful discharges with low risks of readmission.

This is the first attempt to describe and evaluate a discharge planning intervention for detained offenders with ID. The intervention described appears to be a promising approach but further evaluation across a range of service settings is required.

Established following the Reed Report (1991) recommendations, Redford Lodge is an independent psychiatric hospital offering medium secure provision for mentally ill patients and offenders. For this study social and behavioural data were collected on admission and discharge for the 166 patients admitted over the three years 1995‐1998 and 49 discharged patients were reassessed at six‐month follow‐up. Predictors of length of stay, discharge and success at follow‐up were examined in relation to social and demographic factors and engagement in therapy programmes.Patients' socio‐demographic variables were not significantly related to their length of stay, place of discharge or success at follow‐up. One predictor of progress after discharge was employment. Contact with family was identified as a significant factor associated with shorter stay and positive place of discharge but not associated with success at follow‐up. Engagement in psychological therapies and/or group activities was directly related to length of stay, general progress and improvement in mental state but not to subsequent involvement in community services or general success in independent living at follow‐up.Although the findings suggest treatment is successful, further research is needed to identify specific treatment variables that have a positive long‐term effect.

This study aimed to analyze and define the concept of readiness for hospital discharge (RHD) in patients with myocardial infarction (MI).

Walker and Avant's approach was used for concept analysis. Electronic text searches were performed using valid databases with “readiness for hospital discharge” and “MI” keywords. The research included quantitative and qualitative studies related to RHD published between 1997 and 2021 in English and Persian. Out of 103 obtained articles, 29 met the inclusion criteria.

In the analysis, the authors identified stable physical state, desirable individual and social conditions, psychological stability, adequate support, adequate information and knowledge, and multidisciplinary care as the attributes of the determinants of RHD. Antecedents were divided into two categories, including preadmission conditions (economic and social, etc.) and postadmission conditions (disease severity and patient health needs, etc). The consequences were also identified as both positive (e.g. self-care) and side effects (e.g. reduced readmission).

The results showed that the concept of RHD in MI patients is a complex and multidimensional condition that applies to all patients on discharge. It is critical for the care team to pay attention to its attributes and scopes in the process of preparing the patient for discharge. It is also suggested that the concept be used as a nursing diagnosis on the North American Nursing Diagnosis Association (NANDA) list. The Association provides nurses with an up-to-date list of nursing diagnoses.

The purpose of this paper is to present lessons learnt through the development of an evaluation framework for a clinical redesign programme – the aim of which was to improve the patient journey through improved discharge practices within an Australian public hospital.

The development of the evaluation framework involved three stages – namely, the analysis of secondary data relating to the discharge planning pathway; the analysis of primary data including field-notes and interview transcripts on hospital processes; and the triangulation of these data sets to devise the framework. The evaluation framework ensured that resource use, process management, patient satisfaction, and staff well-being and productivity were each connected with measures, targets, and the aim of clinical redesign programme.

The application of business process management and a balanced scorecard enabled a different way of framing the evaluation, ensuring measurable outcomes were connected to inputs and outputs. Lessons learnt include: first, the importance of mixed-methods research to devise the framework and evaluate the redesigned processes; second, the need for appropriate tools and resources to adequately capture change across the different domains of the redesign programme; and third, the value of developing and applying an evaluative framework progressively.

The evaluation framework is limited by its retrospective application to a clinical process redesign programme.

This research supports benchmarking with national and international practices in relation to best practice healthcare redesign processes. Additionally, it provides a theoretical contribution on evaluating health services improvement and redesign initiatives.

National policy in England is now directed towards keeping patients with intellectual disability (ID) presenting with forensic problems for time-limited treatment. The result is that secure hospital services are expected to work much more proactively to discharge patients to community-based services. However, there is little evidence in recent years on the outcome of discharged patients with ID from secure hospitals. The purpose of this paper is to describe the outcomes of a patient group discharged from a specialist forensic ID service in London, England.

This is a descriptive retrospective case note study of patients with ID admitted to and discharged from a secure service with both low and medium secure wards, over a six-year period from 2009 to 2016. The study examined patient demographic, clinical and outcome variables, including length of stay, pharmacological treatment on admission and discharge, offending history and readmissions to hospital and reoffending following discharge.

The study identified 40 male patients, 29 of which were admitted to the medium secure ward. In all, 27 patients (67.5 per cent) were discharged into the community with 14 patients having sole support from the community ID services and 4 from the community forensic services. In total, 20 per cent of patients were readmitted within the study period and 22.2 per cent of patients received further convictions via the Criminal Justice System following discharge.

This was a complex group of patients with ID discharged into the community with a number at risk of requiring readmission and of reoffending. Community-based services providing for offenders with ID must have sufficient expertise and resourcing to manage the needs of such a patient group including the ongoing management of risks. The national drive is significantly to reduce the availability of specialist inpatient services for this group of patients but this must occur alongside an increase in both resources and expertise within community services.