Abstract
Comprehensive and coordinated hospital discharge is fundamental in enabling the continuity of appropriate and efficient care for patients. A whole of system approach is required to improve patient outcomes and experience of health care by implementing a clear and consistent discharge process.
The need for coordinated hospital discharge is supported by recent evidence using linked primary and acute care data in New South Wales. This provided a clear demonstration that visiting a general practitioner soon after discharge for an unplanned hospital stay reduced the rate of readmission to hospital in the short term.
In NSW, a broad range of stakeholders have responsibilities for influencing discharge processes. These include groups within NSW Health and affiliated organisations, as well as the Commonwealth who are responsible for primary care via the Primary Health Networks. Each organisation has responsibility for different aspects of discharge management such as policy and guidance, staff capability, process development and monitoring and evaluation. The current program of work intends to establish a whole of system approach for consistent hospital discharge that maximises continuity of care.
The initial program of work involved a review of discharge practices nationally and internationally to assess the best practice benchmarks that may be applicable to the NSW context. This included a review of current discharge related activity in NSW, which assisted in identifying all the stakeholders required for establishing an advisory panel with comprehensive understanding and responsibility for hospital discharge. This advisory panel will work to identify aspects such as 1) shared priorities, to reduce duplication of activity, 2) gaps in the discharge process, that can be addressed to improve patient care and 3) barriers to coordinated discharge that can be explored and addressed.
The outcomes of this project will be 1) a clear roadmap of responsibilities for hospital discharge in NSW, 2) an agreed streamlined approach to hospital discharge in NSW to optimise continuity of care and, 3) a plan to implement the agreed approach to hospital discharge.