How can we avoid delays in discharging patients from the acute medical unit?

Results

18/27 patients were discharged on weekdays and 9/27 on the weekend. On weekdays, 13/18 were discharged between 8.00am and 5.00pm while 5/18 were discharged after 5.00pm. Between 8.00am and 5.00pm it took 3:13 hours on average to complete the electronic discharge letter (EDL) from the time that the decision to discharge was made. After 5.00pm the mean time taken was 5:12 hours and at weekends it was 1:31 hours. The minimum time taken was 6 minutes and the maximum was 17:00 hours. 10/27 patients had EDLs completed within 1 hour and 5/27 took over 6 hours. We searched the pharmacy tracking system for medication to take home (TTO) dispensing times; only four cases had an accurate record of this. The mean EDL to TTO time was 50 minutes and mean TTO to discharge time was 2:04 hours. We then calculated the overall time gap between decision to discharge and actual discharge from hospital. For weekdays, the mean time taken was 5.00 hours between 8.00am and 5.00pm and 5:30 hours after 5.00 pm. For weekends, it was 4.00 hours. The minimum time taken was 14 minutes and the maximum was 18:30 hours. 2/27 patients were discharged within 1 hour and 9/27 took over 6 hours. Reasons cited for the delays included: junior doctors on ward round with consultants and so unavailable to complete EDLs; delay in doctors informing nursing staff and ward pharmacist of discharge decision; EDL errors requiring amendments; pharmacy delays; difficulties in organising transport; and family/carer issues. Delayed discharges on AMU create bed shortages, thus blocking the transfer of patients from A&E and leading to ambulances queuing up outside. It also distracts nursing resources away from the more sick patients and has financial implications.