Criteria Led Discharge and HITH

Melissa McCusker

Daniel Wilckens

Criteria-led discharge (CLD) – What is it?

• “simple discharge”

• Predetermined criteria for

patient discharge by

Nursing, Allied Health and

junior Medical staff

• Allows for the patient to be

discharged as soon as it is

clinically and socially

appropriate

Why is CLD needed?

• Manage LOS

• Reduce delays to discharge

• Improve utilisation of clinician’s time and skills

• Increased demand and throughput without additional resources

• Key Department of Health Patient Flow Strategy

• Improved patient and staff satisfaction

How does CLD work?

• CLD process is supported by predetermined

criteria set by the HITH Medical Officer (MO)

and a documented procedure with clear

guidelines for use

• An estimated date of discharge (EDD) is

determined on transfer to HITH service

CLD Implementation at the Queen Elizabeth II

(QEII) & Princess Alexandra (PA) Hospitals

• Total of 47 patients in 2013 (9% of all HITH

separations)

– 42 identified as suitable

– 5 did not meet the criteria

• Day of Discharge

– 55% weekday (26)

– 45% weekend discharges (21)

HITH Average Length of Stay

Hospital in the Home Average Length of Stay (ALOS)

2012 vs 2013

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Target

HITH ALOS by DRG

Cellulitis

Hospital in the Home Cellulitis Length of Stay 2012 vs 2013

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HITH ALOS by DRG

Infection

Hospital in the Home Infection Length of Stay 2012 vs 2013

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HITH ALOS by DRG

DVT,PE and AF

Hospital in the Home Length of Stay DVT, PE and AF 2012 vs 2013

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Results

• Nil readmissions

• Nil reported adverse

events

Lessons Learned

• Clinical risk is minimised

• Medical Governance is essential

• Clear pathway if criteria not met

• Must have highly skilled Nursing staff

Acknowledgements

• Hospital Avoidance and Patient Flow Project,

Metro South Health

• Metro South HITH Nursing and Medical team,

with a special mention to Lisa Hauritz, CN

• Clinical Access and Redesign Unit (CARU)

• QEII United Clinical Services Redesign Project