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Developing a Process for Criteria-Led Discharge

Selection of Patients for Efficient and Effective Discharge (SPEED)

Lees-Deutsch, Liz PhD, MSc, Dip HSM, RN; Jackson, Julia MSc, RGN, EN(G); Balaji, Dr Ariyur MD, MRCP (infdiseases), FRCP; Topping, Annie PhD, PGCE, BSc, RN

doi: 10.1097/NCQ.0000000000000423
Original Article: PDF Only

Background: Criteria-led discharge (CLD) is an approach for maximizing bed capacity by expediting patient discharge.

Problem: In acute medicine settings, patients commonly have multiple medical problems, which render single care pathway and clinical protocols of limited use. CLD offers potential, but little evidence exists about how to best implement it in these contexts.

Approach: Retrospective case note analysis generated characteristics from patients' discharge plans to design a criterion-based framework to aid patient selection for CLD. These criteria were hypothetically tested on patient case notes (n = 50).

Outcomes: CLD was identified as suitable (n = 27) and unsuitable (n = 23) from 50 case notes. Interrater agreement was 86% between 3 reviewers.

Conclusions: This review has provided greater understanding of the complexity of discharge in acute medicine settings. Implementing CLD to optimize timeliness of patient discharge might offer a solution for selected patients.

Department of Acute Medicine, Heartlands Hospital (Drs Lees-Deutsch and Balaji and Ms Jackson) and Queen Elizabeth Hospital (Prof Topping), University Hospitals Birmingham Foundation NHS Trust, Birmingham, England; and Nursing School, Institute of Clinical Sciences, University of Birmingham, Birmingham, England (Dr Lees-Deutsch and Prof Topping).

Correspondence: Liz Lees-Deutsch, PhD, MSc, Dip HSM, RN, Heartlands Hospital, University Hospitals Birmingham Foundation NHS Trust, Bordesley Green, Birmingham, West Midlands, B9 5SS, UK (

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Accepted for publication: May 20, 2019

Published ahead of print: July 10, 2019

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