Criteria Led Discharge in Mental Health Inpatient Units
A consumer’s transfer of care (discharge) from hospital back into the community can be delayed for many reasons. We know from consumer surveys and published research that consumers can wait unnecessarily for discharge once they are cleared to leave the hospital. Criteria Led Discharge (CLD) is a process to ensure consumers can return home from hospital and continue on their recovery journey as safely and quickly as possible.
The Criteria Led Discharge model was initially developed by the Acute Care Taskforce (ACT) at the Agency for Clinical Innovation which was rolled out across medical wards state-wide in NSW . Following the evaluation, the model demonstrated significantly improved consumer outcomes (as reported by consumers through Patient Experience Trackers), better engagement of clinicians on the units, a reduction in length of staff of all units involved with no increase to readmission rates.
In response to demand from LHDs around a CLD for Mental Health Inpatient Units, a collaborative between the ACI Acute Care Taskforce, the new ACI Mental Health Network & the Whole of Health Program ( MH stream) was established to lead a CLD working party to explore the validity and demand for a CLD in Mental Health Inpatient Units in LHDs . Following an overwhelming response with over 17 LHD & SHN joining the working party the collaborative commenced due diligence work in partnership with the Mental Health and Drug & Alcohol Office (MHDA) to ensure the model had adequately considered implications from the Mental Health Act 2007 and relevant policies including alignment with the Transfer of Care policy.
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. These specific criteria are will be developed locally by the multidisciplinary team under the leadership of the senior medical clinician.
For appropriate consumers CLD staff that have been suitably senior and deemed competent (e.g. nursing, allied health, junior medical officer) can then facilitate the discharge of a consumer according to the pre-agreed documented criteria. The CLD competent staff member is responsible for monitoring that the CLD criteria have been met.
- To identify a consumer as eligible for CLD on admission (or pre-admission for planned admissions).
- To continue to review consumers mental state every day by the medical team and update the set criteria, if required.
- To agree the criteria and subsequent plan for transfer of care home (discharge) in partnership with the consumer/ carer and the entire health care team.
- For the CLD competent staff member to monitor and record if the patient has met the criteria. This is not a substitute for clinical judgement and if a consumer does not meet the criteria a medical review is necessary.
- For a transfer of care (discharge) checklist to be completed for all consumers, this should include a section on patient education that has been provided (in line with the transfer of care policy).
Goals of Criteria Led Discharge
- Improved consumer and staff experience
- Better engagement with consumers & carers
- Consumers & staff better informed of the care journey
- Transparency on the discharge plan for the entire team
- Improved communication
- Early decisions leading to smooth discharge
- Reduced length of stay
- Increased weekend transfers (discharge) of care
- No increase in readmission rates
- Improved efficiency
What resources are available for Criteria Led Discharge?
The ACI Acute Care Taskforce has developed a set of resources to support the implementation of CLD . The CLD for Mental Health Inpatient Units Working Group have adapted these resources.
- Consumer information
- Staff FAQ fact sheets
- CLD form
- CLD protocol
- a resource called Criteria Led Discharge (CLD): Planning for discharge on admission
- a frequently asked questions leaflet for clinicians and managers implementing CLD
- a CLD form with separate guidance on completing the form
- Two types of patient leaflets:
- guidance on collecting patient and staff experience using Patient Experience Trackers (PETs)
- a draft CLD policy for local adaptation
- a CLD competency set
- an implementation checklist