Discharge Milestones and Delays
Rapid Rounds and Transition Planning information tools help multidisciplinary teams to recognize, record and manage the steps of discharge planning. This includes key events that should occur at specific intervals before an anticipated transition (milestones), early identification and resolution of barriers to an anticipated discharge, and flagging any last-minute (unanticipated) glitches that delay a planned discharge.
Discharge Milestones
Milestones are key events, such as patient education or after-visit summary preparation, that should occur as part of all discharge or transfer pathways.
Milestones are also used to track the initiation of allied health services (e.g., physiotherapy consult) pivotal to getting a patient ready for discharge or transfer. Indeed, any allied health consultation order that might relate to discharge planning automatically generates a discharge milestone specific to that help request. The requested discipline can then resolve (check off) the milestone when work is completed and the patient is ready for discharge or transfer from the perspective of that discipline.
Allied health discharge readiness milestones must all be marked complete (ready for discharge) in order for the Allied Health dimension of overall discharge readiness to be checked complete.
Discharge Barriers
Barriers are patient-specific considerations that delay progression through expected discharge milestones and readiness for discharge. Barriers often require additional coordination or consultations to be resolved. For example, a discharge barrier might be when a patient is waiting on confirmation of a flight time for a repatriation to a northern community.
A discharge barrier is differentiated from a discharge delay by the time frame in which it occurs. Barriers occur at any time during a patient inpatient journey and prevent completion of the Safe Discharge Checklist or progression through discharge milestones. A patient has not achieved readiness as long as unresolved barriers remain.
Discharge Delays
Delays typically affect a discharge or transfer process that has already been approved, requested (ordered) and initiated. The Safe Discharge Checklist and all discharge milestones are complete, but the patient’s departure is postponed in a way that continues to occupy an acute care bed. The reason for transition postponement is the "delay." For example, a discharge delay might be recorded when there is a confirmed time for a repatriation flight but weather prevents the flight from leaving on time.
A discharge delay is differentiated from a discharge barrier by the time frame in which it occurs. Delays occur at the end of a patient journey and are used when a discharge is initiated but departure is postponed. Recording a delay begins a timer, which is displayed for bed planning teams to track, in minutes, how long a patient’s discharge has been delayed.