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Criteria Led Discharge and HITH
Melissa McCusker
Daniel Wilckens
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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
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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
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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
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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)
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HITH Average Length of Stay
Hospital in the Home Average Length of Stay (ALOS)
2012 vs 2013
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Januar
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ALO
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da
ys)
2012
2013
Target
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HITH ALOS by DRG
Cellulitis
Hospital in the Home Cellulitis Length of Stay 2012 vs 2013
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Janu
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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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Days)
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Results
• Nil readmissions
• Nil reported adverse
events
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Lessons Learned
• Clinical risk is minimised
• Medical Governance is essential
• Clear pathway if criteria not met
• Must have highly skilled Nursing staff
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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