Implementation of co-designed hospital outpatient discharge guidelines: a pilot study in cardiology

Background The focus of outpatient demand management is often on incoming referrals and alternative care pathways, but relatively little attention is given to optimising discharge processes followed by clinicians. Timely discharge of patients with stable conditions assists with patient flow, efficient use of specialist services, improved hospital access and waiting times. This implementation study examines how co-designed discharge guidelines affect discharge rates in an outpatient clinic. Methods Discharge guidelines including clinical handover recommendations for General Practitioners (GPs) were developed via a co-design process and implemented in a cardiologyoutpatient clinic in Queensland. A pre-post interventional study design was used to measure the impact of the guidelines on the average discharge rate over a period of 6 months, with and without nurse-prompting. A secure bidirectional electronic messaging system was established to enable general practitioners to seek clinical guidance following patient discharge. Results Following implementation of the discharge guidelines, outpatient discharge rates increased by 40% with nurse-prompting and 30% without. The absolute discharge rate increased from 28.6% in the pre-intervention group to 40.2% with nurse-prompting (+11.6%; p<0.001) and to 37.2% (+8.6%; p<0.001) without prompting. Compared to the pre-intervention group, patients had 67.3% higher odds of being discharged with nurse-prompting (OR = 1.67, 95% CI: 0.35, 0.68) and 47.3% higher odds without prompting (OR = 1.47, 95% CI: 0.22, 0.56). Conclusion The implementation of co-designed cardiology discharge guidelines results in a statistically significant improvement in discharge rates.