Smooth Sailing: Improving Discharge Readiness and Early Discharges on an Older Person's Ward Using a Standardised Checklist

Introduction

Timely and safe patient discharge is essential for quality care of older adults. On our 28-bedded older persons’ ward, frequent barriers—delays in electronic discharge letter and prescription(EDL/TTO), pharmacy screening, transport, package-of-care coordination, and carer updates —contributed to late and incomplete discharges. Baseline observations demonstrated variable completion of discharge tasks and inconsistent communication within the multidisciplinary team(MDT).This resident doctor lead project introduced a standardised checklist to improve discharge efficiency.

Methods

A quality improvement project using two PDSA cycles was undertaken.

PDSA Cycle 1: A standardised discharge-readiness checklist was implemented on the ward whiteboard to improve visibility of tasks, including EDL/TTO completion, carer updates, transport, package-of-care, and provision of equipment. Staff were educated on its use, and the checklist was reviewed daily during morning board round.

PDSA Cycle 2: Based on feedback and limitations of the physical board, the checklist was integrated into our electronic health record system allowing accessible, real-time digital updates.

Data were collected daily on the percentage of discharges discussed in the morning board round that were completed before 12:00 (“golden discharges”) and by 17:00. Pre- and post-intervention staff questionnaires assessed communication, workflow, and confidence in discharge processes.

Results

Run chart analysis demonstrated a reduction in incomplete discharges (discharge not occurring because a task not complete) from 33.3% to 0% following Cycle 1, sustained after Cycle 2. Golden discharges increased from 0% to 40% after Cycle 1 and 50% after Cycle 2. Discharges discussed during morning board rounds were more likely to be completed by 17:00. Pre-intervention surveys showed 40% staff confidence in task completion and 80% reporting poor MDT communication (n=10). Post-intervention, 88.9% reported the checklist was easy to use and MDT communication had improved (n=9).

Conclusion

A whiteboard-based discharge checklist, followed by digital integration, led to sustained improvements in discharge readiness, early discharges, and improved MDT communication.