Despite the fact that improved discharge planning has been a consistent recommendation in health policy and research, there is no commonly agreed model for the process of discharge (Waring et al. [52]). The process for discharging patients at ward level should, however, be standard for all simple discharges across the hospital. NHS Improvement (NHSI) ([32]) has developed a toolkit on discharge planning and highlighted key elements that are essential for both elective and emergency admissions:

NHSI ([32]) also says: ‘A specific targeted discharge date and time reduces a patient's length of stay, emergency readmissions and pressure on hospital beds’ (p.2). Discharge dates in elective care can be planned prior to admission; if patients have attended a pre‐assessment appointment, discharge needs should be identified at this point to allow effective planning and to enable clinical staff to notify appropriate services in advance of admission (NICE [37]). Advance planning is not possible in emergency or unscheduled care so in these circumstances robust systems of patient assessment are crucial to gather relevant patient information early (Lees‐Deutsch et al. [23]). An estimated date of discharge can then be agreed for everyone to work towards. The date may change depending on clinical and individual patient needs since changes in patients’ medical conditions require ongoing reassessment and should be the foundation of decisions about timing (Weiss et al. [53]). The expected date of discharge should therefore be continually reviewed based on the consultant's judgement as to when the patient is likely to have recovered sufficiently to go home. This is best done by establishing the clinical criteria for discharge, which are the functional and physiological parameters that the patient must achieve before discharge (NHSI [35]). These criteria enable everyone to focus on the same factors, which helps in communication and facilitates more effective discharge planning. Due to the rapidly aging population, the increasing number of people living with long‐term conditions (such as dementia) and the decreasing number of hospital beds, the pressure to discharge patients quickly is a continuous challenge for the NHS (Ewbank et al. [14]). As a result, there have been many recent reports, recommendations and initiatives to improve discharge planning from statutory and voluntary bodies (e.g. Healthwatch England [17], NHS England [30], NICE [37], QNI [44], Royal Voluntary Service [46]).

The SAFER Patient Flow Bundle (NHSI [33]) is a structured approach that uses five elements of best practice to improve discharge planning (Figure 3.2).

The Red to Green approach, which works in tandem with the SAFER Patient Flow Bundle, highlights those days when a patient receives little or no intervention; these days progress them towards discharge (Figure 3.3). Green days are of value to a patient as they receive care that contributes towards them getting home. By using this approach, hospitals can see where there are blockages in their discharge processes and make changes for improvement. For example, a high number of patients may have red days because they are waiting for a scan before discharge. By reviewing the radiology scheduling, the hospital could implement changes to fast‐track patients who are awaiting discharge, which could prevent discharge delays.

Nurse‐led and criteria‐led discharge have both been developed within the past decade as ways to expedite timely discharge for patients. Both require the clinical parameters for a patient's discharge to be clearly defined; once these have been met, discharge can be facilitated by a competent member of staff (Lees‐Deutsch and Robinson [22]). For nurse‐led discharge to be undertaken, nurses require specific training to ensure competency in the continuing assessment of patients for discharge, whereas criteria‐led discharge is an approach that can be used by a range of professionals. Criteria are often developed from clinical guidelines for specific conditions (Cundy et al. [11]) and their use can appropriately inform practitioners about the patient's clinical readiness for discharge. However, effective discharge extends beyond the use of criteria in isolation (Lees‐Deutsch and Gaillemin [21]) and nurses must focus on their accountability for delivering holistic care throughout the discharge planning process.

Introducing frameworks and approaches to discharge planning can support the process and improve efficiency, organization and overall satisfaction of patients and staff (Lees‐Deutsch and Gaillemin [21]). Such methods help to reduce time lags in the traditional discharge process, thereby reducing length of stay and improving patient safety.