Abstract
Background: Criteria Led Discharge (CLD) is advocated globally as a way of improving patient flow in hospital by bringing forward the time of patient discharge. Problem: Complexities regarding the heterogeneity of patient conditions have inhibited development of CLD in acute medicine. A Standard Operating Procedure (SOP) was operational for CLD although this had not been introduced in practice within acute medicine. Approach: Prospective observation of the CLD procedure in practice through testing which included; staff involvement, development of supporting tools, interrogation of patient clinical criteria and staff feedback. Design, data collection and analysis were undertaken using the Cultural Historical Activity Theory (CHAT) to reveal contradictions to the SOP in acute medicine. Outcomes: Common and special cause contradictions to the SOP were revealed namely; delay in writing discharge medications / GP letters and nurses being unable to routinely participate in the patient clinical reviews. Staff were engaged with usual discharge practices, which effectively isolated them from agreed activities to support CLD. Conclusion: activities within the SOP need to be routinely and systematically supported in order for the CLD SOP to be successfully implemented in acute medicine. Oversight and continuity from acute medicine consultant team is also essential.
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