Development of a survey tool to demonstrate opportunities and characteristics of patients suitable for criteria led discharge from hospital - a multi-centre study with participatory co-design
Lees-Deutsch, Liz Young, Rosslyn Abraham, Jenny Brangwin, Emma Edge, Lucy Widdowson, Deborah Parr, James Crombie, Aisling Staveley, Imogen Morgan, Nina
Lees-Deutsch, Liz
Young, Rosslyn
Abraham, Jenny
Brangwin, Emma
Edge, Lucy
Widdowson, Deborah
Parr, James
Crombie, Aisling
Staveley, Imogen
Morgan, Nina
Affiliation
University Hospitals Coventry and Warwickshire NHS Trust; Coventry University; NHS England; University Hospitals Birmingham NHS Trust; Hereford and Worcestershire Integrated Care Board; Coventry and Warwickshire Integrated Care Board
Other Contributors
Publication date
2025-11-19
Subject
Collections
Research Projects
Organizational Units
Journal Issue
Abstract
Background: Criteria Led Discharge (CLD) provides an opportunity to improve in-patient flow by bringing the time of patient discharge earlier in the day. CLD is an intervention that creates clinical criteria and parameters for safe patient discharge. Used effectively, it can aid the delegation of decision-making from senior decision-makers to appropriately registered clinical practitioners. Despite national guidance regarding the implementation of CLD, it remains sporadic in some healthcare settings and is not embedded into discharge practice. We aimed to develop a survey tool to understand the patients’ characteristics and opportunities for criteria-led discharge in acute hospital settings. We hypothesised the survey tool would engage multidisciplinary staff, demonstrate opportunities for CLD development, and cultivate data on patient characteristics suitable for CLD. This paper describes the development of a point prevalence patient survey tool and the opportunities for CLD.
Methods: Multi-centre study with participatory co-design using multi-methods (operational and participatory action research) to sequentially develop the point prevalence survey tool, with feasibility testing. Feasibility was guided by eight developmental phases: acceptability, demand, practicality, implementation, adaptation, integration, efficacy, and expansion. User testing, through facilitated co-design enabled feedback from healthcare staff for the tool reiterations. Categorical data were analysed descriptively. Change theory was employed to understand the associated organisational elements: Capability, Opportunity, Motivation, and Behaviours (COM-B).
Results: A point prevalence survey tool capable of illuminating the characteristics and opportunities of patients potentially suitable for CLD was developed. The tool stimulated multidisciplinary team engagement at pace and scale across 39 organisations, involving 83 hospital wards. 47% (mean) of patients 2174 surveyed occupying hospital beds were suitable for a CLD. There was almost equal opportunity across elective and non-elective care, with the greatest opportunity in discharge pathways 0 and 1.
Conclusion: This study authenticates the point prevalence survey tool through multicentre, multi-professional testing and application. It demonstrates the opportunities and characteristics of patients hypothetically suitable for CLD. Application of the survey tool is a sustainable and generalisable mechanism to regularly appraise the opportunities and promote communication about CLD. Staff indicated that the tool provided an acceptable and innovative approach to challenging patient discharge scenarios and consider the suitability of patients and condition groups for CLD.
Citation
Lees-Deutsch L, Young R, Abraham J, Brangwin E, Edge L, Widdowson D, Parr J, Crombie A, Staveley I, Morgan N. Development of a survey tool to demonstrate opportunities and characteristics of patients suitable for criteria led discharge from hospital - a multi-centre study with participatory co-design. BMC Health Serv Res. 2025 Nov 19;25(1):1492. doi: 10.1186/s12913-025-13734-1.
Type
Article