Criteria-Led Discharge in Acute Medicine: Improving Patient Flow Through Clearer Discharge Planning

Introduction

Delayed discharge worsens patient outcomes, increasing risk of hospital associated infections and reducing patient flow. Criteria-Led Discharge (CLD) enables multidisciplinary teams (MDT) to discharge patients once predefined clinical criteria are met, without needing a final senior clinician review. This quality improvement project evaluated CLD documentation and its association with discharge 24-48 hours later, staff awareness and barriers to CLD use. 

Method

A Plan–Do–Study–Act cycle was completed across the Acute Medical Unit, Acute Medical Assessment unit, Medical Short Stay Unit and post-take. Between March and May 2026, 800 patient episodes were analysed and 217 met predefined inclusion criteria. Electronic records were reviewed for CLD documentation, timing, discharge date and staff grade facilitating discharge. An MDT survey assessed staff awareness, confidence and barriers to CLD use. Interventions included a CLD standard operating procedure, targeted teaching, posters and point-of-care guidance. To embed CLD into routine workflow, a mandatory “Criteria-Led Discharge” section has been built into the Sunrise electronic patient record, prompting completion when a patient is deemed medically fit for discharge; roll-out is scheduled for 28 September 2026.

Results

CLD was documented in 129/217 patients (59.4%), of whom 102/129 (79.1%) were discharged within 24–48 hours. Of all CLDs, 60/129 (46.5%) were documented during post-take review. Patients with CLD were predominantly discharged by resident doctors and nurses, whereas those without CLD were predominantly discharged by consultants. Among 24 staff respondents, 15/24 (62.5%) were aware of CLD and 12/24 (50.0%) reported inadequate training. Fear of error or medico-legal consequences was the most frequently reported barrier.

Conclusion(s)

CLD was associated with timely multidisciplinary discharge, with four in five patients discharged within 48 hours. Inconsistent uptake and staff confidence limited reliability. Standardised criteria, education and mandatory electronic documentation provide a scalable approach to embedding CLD and reducing waits for senior-led discharge.