A column by Maureen Flynn

This month’s focus is on quality and safety in discharge or transfer from hospital. The practical guide to integrated care is designed to support healthcare providers to improve their discharge and transfer processes from the acute hospital setting back into the community, and thereby support the delivery of high quality safe care.

The National Integrated Care Guidance (2014) has been developed by the National Integrated Care Advisory Group chaired by Liam Duffy under the auspices of the Quality and Patient Safety Division. It is based on feedback received following extensive national and targeted consultation with service providers in both the acute and community healthcare settings and on review of the HSE Integrated Discharge Planning Code of Practice (2008).

The Integrated Care Guidance (2014) replaces the existing HSE Integrated Discharge Planning Code of Practice (2008).

What is integrated care
It is the ‘processes, methods and tools’ of integration that facilitate integrated care. Integration involves connecting the healthcare system (acute, community and primary medical) with other service systems such as long-term care, education or housing services.¹

The guidance describes nine key steps in effective discharge and transfer of care that can facilitate faster, safer discharges for patients (see graphic). These steps include identifying whether the person has simple or complex discharge needs, setting an expected date of discharge/ transfer and reviewing treatment plan with the person on a daily basis.

Nine steps in effective discharge and care from hospital to community

The Integrated Care Guidance document contains process maps and is supported by: 1) a two-page, nine-step checklist for ease of reference; 2) the principles of the patient charter; 3) medication reconciliation process flow for admission to and discharge from acute care; 4) a service user discharge tracking form; 5)criteria for nurses (or health and social care professional/ other) to undertake discharge; and 6) rapid discharge planning guideline summary.

This guide will support service providers in demonstrating how they are meeting the National Standards for Safer Better Healthcare (NSSBH),² and the High Impact Changes required to Improve Performance with Unscheduled Care.³

Opportunity to use the resources
This guidance will be of assistance to you in reviewing or auditing your ward, unit or service discharge and transfer practices. To start, you may undertake an assessment using the nine steps for effective discharge and transfer and using the checklist provided in the document. This will help to identify strengths, weaknesses and opportunities for improvement. The guidance may also be of assistance if you are reviewing or developing new forms for discharge.

Clarifying changes and actions required to improve outcomes in terms of effective discharge and transfer from the hospital will focus on and drive improvement in the organisation. The guidance document and checklist can be accessed via the Quality and Patient Safety Division home page at http://www.hse.ie/go/qps

Any feedback on experiences of using the resources, and how they might be improved, is most welcome. For further information, contact Angela Hughes, National Integrated Care Guidance lead at the HSE Quality and Patient Safety Division. Email: angela.hughes@hse.ie

Maureen Flynn is the director of nursing (national lead for quality and safety governance development) at the Office of the Nursing and Midwifery Services Director, Quality and Patient Safety Division HSE

Acknowledgement: The National Integrated Care Guidance has been developed by the National Integrated Care Advisory Group under the auspices of the Quality and Patient Safety Division. With thanks to Liam Duffy, chair and members of the National Integrated Care Advisory Group and the many staff, service users and members of the public who made submissions during the development of the guidance document. References on request from nursing@medmedia.ie (Quote Flynn, M. WIN 2014; 22(4): 25)

Quality & Safety - Integrated Guidance: A guide to discharge and transfer from hospital