Neobook — clinical reference

Purpose: To provide a guideline on discharge planning.

Goal: All hospital wards should aim to have 90% of patients discharged by 10h00 on the day that patients are clinically fit to be discharged and

to have 80% of those patients out of wards by 12h00 daily.

Principles of Discharge planning

Discharge planning starts at or before admission of the patient to hospital
It involves identifying the requirements the patient and family will have to allow the patient to return to the community
It involves identifying social, physiotherapy, occupational therapy and placement requirements as well as all outpatient follow up requirements
The patient and care givers must be involved in these plans
The actual discharge instructions are the plans made on discharge
These discharge instructions should not be initiated when the patient is medically well to leave the hospital, but should be thought about early in the hospital admission and continually updated
Part of discharge planning includes identifying patients for next day discharge to the nursing staff, completing discharge summaries the day before discharge, prescribing the TTOs the day and preparing family for collection of the patient.

Discharge Planning

Starting your discharge plan

Each patient admitted to a ward must have a documented discharge plan by the senior attending clinician (consultant) at least within 24 hours after admission.

A discharge plan are the care requirements which have to be completed to allow for safe discharge

This will be in conjunction with the in hospital treatment plan

Updating discharge plan

It is the responsibility of the attending clinician to ensure that the discharge plan is updated daily.

The attending clinician should also identify if patients will need allied health intervention (OT, Physiotherapy, Dietitian etc.) and communicate it to the relevant departments within 24-48 hours of admission or within 1 working day of when it is discovered a patient needs such services.

If a patient needs social intervention, the attending clinician must ensure that the social worker of the department is informed as soon as such a need is identified.

If the patient requires follow-up outpatient appointments and/or radiological investigations, these should be arranged on identification of the need and after timeous consultation with the senior attending clinician (consultant).

Discharge Process

Discharge Decision	The attending clinician must communicate the decision to be discharged a day before the actual discharge date. This decision must be communicated to the nursing staff to start the discharge preparation for the following day. This decision is also to be communicated to the patient, so that they can arrange transport. On the day of discharge, the attending clinician is to see the patient at the start of their work day in order to confirm the discharge decision.
Writing TTO	The attending clinician must ensure that all TTOs are completed and given to the nursing staff for processing the day before patients are being discharged.
TTO to Pharmacy and back	The Sister (shift leader) must ensure that all TTOs are sent to pharmacy before 15h30 for the latest on the day before discharge or at 08h00 on the day of discharge if they cannot be sent the day before. The messenger should collect the TTOs and transfer it to pharmacy for processing before 15h30 the day before or by 08h00 on the day. Alternatively, TTOs can be sent to pharmacy via the shute in order to have them processed timeously. The clerk should telephonically inform pharmacy that TTOs has been sent via the shute within 15 minutes after sending. Pharmacy should process discharge medication and send it to the ward or the transit lounge as indicated on the discharge TTOs
How to use the shute system	Put completed TTOs inside shute bullet. Place bullet into the shute, close it and punch in appropriate code. Codes for wards are as follow: A 40: G25, F25, F26, E26, C26, C27 B 40: G16, G17, F16, F17 C 40: G7, G8, F7, F8, E7 D 40: G22, G23, F22, F23, D24, C22, C23 E 40: G12, F12, E12, D12, D13 F 40: G4, G5, F5, F4, D4 H 40: D14, D15, C14, C12, C5, C13, C15, C24 K 40: Maternity After TTOs are sent to the pharmacy, the sister must phone 3218/9 to check if the TTO reached pharmacy.
Contact Relatives	The sister must inform the relatives of patients due for discharge after the discharge decision has been made in order that they can make arrangements to collect the patient on the day of discharge. The sister must clearly indicate where the discharged patient will be collected (either ward or transit lounge) and provide the relatives with the necessary contact details. This will allow relatives enough time to make arrangements to collect patients sooner.
Writing discharge letter	The attending clinician must ensure that all discharge documentation is complete (e.g. discharge letters, sick notes, ECCR record etc.) before the day of discharge. On the day of discharge the dates can be finalised and the necessary letters can be signed, printed and given to the ward clerks for processing by latest 10h00. Future appointment dates must also be finalised with ward clerks by 10h00.
Patient transferred to Transit Lounge	The attending clinician must identify which patients can be sent to the transit lounge. The sisters can assist the doctors in identifying such patients. The sister must ensure that all discharged patients identified as transit lounge movers, must be prepared and transferred to the transit lounge by latest 12h00 on the day of discharge. Families should also be informed to collect their relative by 12h00 of the day if discharge (this will be possible if the TTOs and discharge summaries were all completed the previous day) Patients that do not fit the criteria for the transit lounge must be collected by their relatives in the ward.
Porters	The ward sister must phone a porter to collect the patients in the ward when the patient’s family arrives.

ICD-10 codes