ArticleBMC health services research2025
Development of a survey tool to demonstrate opportunities and characteristics of patients suitable for criteria led discharge from hospital - a multi-centre study with participatory co-design.
Article in BMC health services research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCriteria Led Discharge (CLD) provides an opportunity to improve in-patient flow by bringing the time of patient discharge earlier in the day. CLD is an intervention that creates clinical criteria and parameters for safe patient discharge. Used effectively, it can aid the delegation of decision-making from senior decision-makers to appropriately registered clinical practitioners. Despite national guidance regarding the implementation of CLD, it remains sporadic in some healthcare settings and is not embedded into discharge practice. We aimed to develop a survey tool to understand the patients’ characteristics and opportunities for criteria-led discharge in acute hospital settings. We hypothesised the survey tool would engage multidisciplinary staff, demonstrate opportunities for CLD development, and cultivate data on patient characteristics suitable for CLD. This paper describes the development of a point prevalence patient survey tool and the opportunities for CLD.
methodsMulti-centre study with participatory co-design using multi-methods (operational and participatory action research) to sequentially develop the point prevalence survey tool, with feasibility testing. Feasibility was guided by eight developmental phases: acceptability, demand, practicality, implementation, adaptation, integration, efficacy, and expansion. User testing, through facilitated co-design enabled feedback from healthcare staff for the tool reiterations. Categorical data were analysed descriptively. Change theory was employed to understand the associated organisational elements: Capability, Opportunity, Motivation, and Behaviours (COM-B).
resultsA point prevalence survey tool capable of illuminating the characteristics and opportunities of patients potentially suitable for CLD was developed. The tool stimulated multidisciplinary team engagement at pace and scale across 39 organisations, involving 83 hospital wards. 47% (mean) of patients 2174 surveyed occupying hospital beds were suitable for a CLD. There was almost equal opportunity across elective and non-elective care, with the greatest opportunity in discharge pathways 0 and 1.
conclusionThis study authenticates the point prevalence survey tool through multicentre, multi-professional testing and application. It demonstrates the opportunities and characteristics of patients hypothetically suitable for CLD. Application of the survey tool is a sustainable and generalisable mechanism to regularly appraise the opportunities and promote communication about CLD. Staff indicated that the tool provided an acceptable and innovative approach to challenging patient discharge scenarios and consider the suitability of patients and condition groups for CLD.
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