International Journal of Healthcare Simulation

Background and aim:

Delayed discharges are a challenge in every hospital. The Scottish Government are ‘committed to significantly reducing the number of people who are waiting to move from hospital wards to more appropriate settings [1]. This transformative simulation has been designed for all multidisciplinary team members involved in a patient’s care to engage in discharge planning; and to ‘respond to health service needs [2]. This simulation was created to break down barriers between acute and community care, reduce silo mentality and share the decision-making and risk around discharge.

Aims:

Empower any member of staff to have discharge conversations.

Emphasis on early discharge conversations.

Join up acute and community staff involved in the discharge process.

Activity:

The simulation involves a three-hour session with three scenarios. The session has run in both acute and community hospitals. Participants are multidisciplinary, and have included doctors, nurses, allied-health professionals (AHP), flow team, carers representatives, social workers, social care staff, home care staff and NHS Education for Scotland (NES) staff. The participants, in pairs, have a simulated conversation with a patient’s relative about discharge. The learning objectives from the scenarios are around realistic medicine, managing risk and dealing with anxious families.

To assess the immediate impact of the simulation, participants complete a pre-simulation questionnaire on arrival and a post-simulation questionnaire at the end of the session.

Findings:

The results were from the pilot session pre and post simulation questionnaires in March 2023. Participants (n = 10) were asked ‘How would you rate your willingness to have discharge conversations with patients/family members?’ before the simulation the mean rating was 3.8 out of 5. Following the simulation, the participants were asked ‘To what extent does this training empower you to have discharge conversations?’ and the mean rating was 4.7 out of 5. This demonstrates that the simulation increased willingness and empowerment to have discharge conversations.

Prior to the simulation participants were asked ‘What makes it difficult to have these conversations?’ Themes from the qualitative answers were family expectations and managing uncertainty, both of which were learning objectives in the scenarios.

Conclusion:

Our participant feedback has shown that this Discharge without Delay Simulation has ‘made discharge everyone’s business.’ This simulation can provide transformative change to help healthcare professionals have early discharge conversations. This provides better patient-centred care by returning the patient to a homely environment, to reduce delayed discharges and increase patient safety.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.