Policies, Procedures and Guidelines for Criteria-led Discharge:A Scoping Review

_{Introduction: Criteria Led Discharge (CLD) enables the delegation of selective patient<br/>discharges to to non-medical registered healthcare practitioners through clinical criteria,<br/>determined by a senior medical decision maker1. CLD can contribute to freeing bed capacity<br/>earlier in the day2<br/>. However, evidence-based research into the effectiveness of CLD remains<br/>limited and implementation has been termed variable and inconsistent3,4<br/>.<br/>This scoping review focuses of international policies, procedures and guidelines relating to CLD<br/>within acute hospitals aimed to describe CLD implementation processes and to explore<br/>prerequisite human behaviours for implementation from policy to practitioner level.<br/>Methods: Searches of publicly available regional, national and international documents on CLD<br/>was undertaken from grey literature databases, Google and websites, plus calls for evidence. A<br/>methodological framework from Joanna Briggs Institute was adapted5<br/>.<br/>The search strategy included all identified keywords, and was adapted for each data source.<br/>Evidence published in English only was sought via a targeted search from January 2014 to April<br/>2024. Two independent reviewers conducted screening. End-user collaboration was used<br/>throughout the scoping review process with engagement from the NHS Emergency Care<br/>Improvement Support Team and subject experts.<br/>Results: 20 documents (6 countries) provided policies, guidelines, guidance, protocols,<br/>procedures and toolkits. Twelve included reference to the evidence base but the extent to which<br/>it was used varied. Six documents presented the process stages of CLD but didn’t document<br/>implementation processes. Only 2 focused solely on implementation with just one referencing<br/>behaviour related to CLD implementation. The remainder using directive terminology but lacked<br/>specificity in actions required.<br/>Conclusion: This review demonstrates evidence-based rationale and implementation processes<br/>and behaviours, is sporadic. Given the heterogeneity in purpose and scope of these documents,<br/>detailed information on implementation processes is limited. This review will inform future<br/>implementation studies and recommendations for CLD policy development.<br/>REFERENCES<br/>1. NHS England. (2022). Rapid improvement guide to criteria-led discharge .<br/>https://transform.england.nhs.uk/improvement/100-day-discharge-challenge/ten-best-practice-<br/>initiatives/supporting-information/rapid-improvement-guide-to-criteria-led-discharge/<br/>2. Lees-Deutsch, L., &amp; Robinson, J. (2019). A Systematic Review of Criteria-Led Patient Discharge.<br/>Journal of Nursing Care Quality , 34 (2), 121–126.<br/>https://doi.org/10.1097/NCQ.0000000000000356<br/>3. NHS England, &amp; NHS Improvement. (2021). Improvement guidance for writing a criteria-led<br/>discharge policy . Generic . https://www.england.nhs.uk/wp-content/uploads/2021/10/B0928-<br/>criteria-led-discharge-guidance-v2.pdf<br/>4. Brangwin, Emma, &amp; ECIST. (2023). December ECIST meeting: CLD menti feedback.<br/>5. Peters, M. D. J., Marnie, C., Tricco, A. C., Pollock, D., Munn, Z., Alexander, L., McInerney, P.,<br/>Godfrey, C. M., &amp; Khalil, H. (2020). Updated methodological guidance for the conduct of scoping<br/>reviews. JBI Evidence Synthesis , 18 (10), 2119–2126. https://doi.org/10.11124/JBIES-20-00167<br/>PRESENTED BY<br/>Mrs. Emma Brangwin<br/>Coventry University - (⚑ United Kingdom)<br/>AUTHORS<br/>1.<br/>Mrs. Emma Brangwin (⚑ United Kingdom) 1<br/>2.<br/>Dr. Agnieszka Lewko (⚑ United Kingdom) 1<br/>3.<br/>Prof. Liz Lees-Deutsch (⚑ United Kingdom) 1<br/>1. Coventry University<br/>LEAD PRESENTER BIOGRAPHY<br/>Emma is a Doctoral Student completing her PhD with Coventry University in the Midlands, UK.<br/>She remains employed by UHCW NHS Trust as a physiotherapist and works clinically within<br/>Orthopaedics one day a week.<br/>The aim of the PhD is to explore the ‘elephants in the room’ surrounding CLD implementation<br/>and will seek to understand the necessary motivators required to change the behaviour of<br/>healthcare professionals, doctors and managers in order to increase engagement with a<br/>complex intervention such as CLD. This would be done using proven implementation science<br/>theory such as Michie’s ‘Behaviour Change Wheel’.<br/>TOPICS<br/>Clinical topic, research field and research issues: Service innovation and improvement<br/>Research approach: Systematic review or other secondary research<br/>Data collection or analysis method: Other collection or analysis method}