Criteria Led Discharge
A patient's transfer of care (discharge) from hospital can be delayed for many reasons. We know from patient surveys and published research that patients can wait unnecessarily for discharge once they are medically cleared to leave the hospital. Criteria Led Discharge ( CLD ) is a process to ensure patients can return home from hospital as safely and quickly as possible.
What is best practice for Criteria Led Discharge?
Under CLD the decision for discharge is made and documented by the senior medical clinician (e.g. Senior Consultant, Medical Fellow, Visiting Medical Officer). Additional criteria may be added by the interdisciplinary team members.
For appropriate patients CLD competent staff (e.g. nursing, allied health, junior medical officer) can then facilitate the discharge of a patient according to documented criteria. The CLD competent staff member is responsible for monitoring that the CLD criteria have been met.
Best practice for CLD is:
- To identify a patient as eligible for CLD on admission (or pre-admission for planned admissions).
- To continue to review patients every day by the medical team and update the set criteria, if required.
- To agree the criteria and subsequent plan for discharge in partnership with the entire health care team, including the patient and/or their carer.
- For the CLD competent staff member to monitor and record if the patient has met the criteria. This does not substitute for clinical judgement and if a patient does not meet the criteria a medical review is necessary.
- For a transfer of care (discharge) checklist to be completed for all patients, this should include a section on patient education that has been provided.
Goals of Criteria Led Discharge
- Improved patient and staff experience
- Improved communication
- Better informed patients
- Transparency on the discharge plan for the entire team
- Improved efficiency
- Early decisions leading to smooth discharge
- Reduced length of stay
- Increased weekend transfers (discharge) of care
- No increase in readmission rates
What resources are available for Criteria Led Discharge?
Criteria Led Discharge Toolkit - A resource to support the implementation of CLD
This toolkit (PDF 2.7MB) gives a brief overview of CLD and describes the resources available to assist sites to:
- assess their readiness for CLD implementation
- create a governance structure
- plan implementation
- create CLD resources
- train staff
- educate patients
- collect indicators
- assess outcomes
- Appendix 1 – CLD site readiness survey (PDF File )
- Appendix 2a – CLD protocol template (MS Word Document )
- Appendix 2b – Mental health inpatient template (MS Word Document )
- Appendix 3 – CLD implementation checklist (MS Word Document )
- Appendix 4a – CLD respiratory pre-set criteria (PDF File )
- Appendix 4b – CLD TIA pre-set criteria (PDF File )
- Appendix 4c – CLD form generic (PDF File )
- Appendix 4d – POW CLD form generic (PDF File )
- Appendix 5 – Transfer of care checklist (PDF File )
- Appendix 6 - CLD PowerPoint presentation (MS PowerPoint Document )
- Appendix 7a – CLD one page summary (MS Word Document )
- Appendix 7b – CLD FAQ mental health inpatients (MS Word Document )
- Appendix 8 – CLD training worksheet (PDF File )
- Appendix 9a – CLD patient leaflet (ACI) (MS Word Document )
- Appendix 9b – CLD Consumer Information (ACI) (MS Word Document )
- Appendix 9c – Dubbo Hospital consumer leaflet (PDF File )
- Appendix 9d – Northern Sydney LHD consumer leaflet (PDF File )
- Appendix 9e – Concord Hospital consumer leaflet (PDF File )
- Appendix 10 – Patient and staff experience tracker information report (PDF File )
- Appendix 11 – Data collection template (Western NSW) (PDF File )
For further information please contact Sue Schasser.
The ACI Acute Care Taskforce has developed a set of resources to support the implementation of CLD .
- a resource called Criteria Led Discharge (CLD): Planning for discharge on admission
- a frequently asked questions leaflet for clinicians and managers implementing CLD
- Two types of patient leaflets:
- a CLD form with separate guidance on completing the form
- Two CLD forms with guidance on completing the form:
- a suggested transfer of care checklist
- guidance on collecting patient and staff experience using Patient Experience Trackers (PETs)
- a draft CLD policy for local adaptation
- a CLD competency set
- a draft set of orientation/education slides
- an implementation checklist
Download the complete set of resources (ZIP file - 3.7Mb)
Local Innovations for Criteria Led Discharge
Since early 2014 teams have been developing a local approach to improving patient care through more standardised discharge practices. Some of the local innovations are listed below. If you would like your CLD form added to these innovations please email Sue Schasser, Manager, Acute Care on firstname.lastname@example.org.
- CLD for Haematology patients (Calvary Mater Newcastle)
- CLD for short stay surgical patients (Lismore Hospital)
- CLD for respiratory/COPD patients (testing draft) (Prince of Wales Hospital)
- CLD for aged care patients (testing draft) (Prince of Wales Hospital)
- CLD for total hip, knee replacements, Transient Ischaemic Attack, Permanent Pacemaker, Post Percutaneous Coronary Intervention, Total Shoulder Replacement (Wollongong Hospital)
Dubbo Hospital has also developed a revised CLD patient leaflet (testing draft).
Royal Prince Alfred Hospital has adapted the CLD process to develop criteria for transfer to Balmain Hospital from RPA Geriatric Medicine. This form clearly outlines the process for transfer and the criteria for transfer. A PDF version of the form can be downloaded: Criteria Led Transfers between RPA and Balmain Hospital.
Where can I get more information about support for implementing Criteria Led Discharge?
Testing of the CLD resources in NSW began in August 2013 and the ACI Acute Care Taskforce has been supporting teams implementing CLD 2014-2019.
For more information contact Linda Soars, Clinical Associate Director, ACI Linda.Soars@health.nsw.gov.au