Archived August 20 2008 - may contain information of historical interest (some links may not work)

Welcome to the Effective Discharge Strategy Program Web site

The Effective Discharge Strategy (EDS) was a five-year initiative spanning the period from 1998/99 to 2002/03. It applied to all Victorian public hospitals (acute, sub-acute and Multi Purpose Services (MPS). The EDS was a systematic approach to understanding, measuring and improving the planning processes for the transition of patients from hospital to the community and their associated outcomes. This was achieved by:

• Supporting health care providers to review and improve transition processes and practices.
• Developing robust performance indicators that measure the effectiveness of transition processes.

The objectives of the Strategy were to:

• Improve the continuity of care for patients.
• Promote communication and integration with community providers.
• Improve services and health outcomes through measurement of performance and provision of feedback to public hospitals.

Over the term of the strategy a number of significant projects were undertaken that have focussed on improving and facilitating good transitioning practices and processes in hospitals and the seamless transition of patients from hospital back to the community. Hospitals received substantial state funding to enable them to undertake specific discharge related activities. In addition to improving transition practices in Victorian hospitals, the strategy has been significant in that it has facilitated a more open and collaborative approach to work practices within hospitals, between hospitals and between hospitals and community providers. The relationships established as a consequence of the strategy will be important in the success of future initiatives and ongoing working relationships within the broader health sector.

To guide the department in the implementation of the strategy in the first 18 months, an Expert Advisory Group with representation from the field was established. Membership included representatives from health services (medical, nursing, information technology), general practice, community health, local government, aged care, consumer groups, Royal District Nursing Service, academia and the department.

The strategy was funded to a total of $42 million over the five years. $37 million of this money was distributed directly to Victorian hospitals to fund discharge improvement processes. The majority of hospitals used part of their allocated funding to employ a project officer to ensure the success of the strategy within their organisation. Hospitals used the remaining money to fund a variety of activities.

The initiatives undertaken throughout the Strategy can be broadly described as follows:

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1. Discharge Process Improvement

The development and implementation by health services of Discharge Improvement Plans was designed to improve discharge processes and practices. The aim was to develop systems and processes to ensure that all patients are risk screened prior to, or, on admission to hospital to enable requisite post-discharge services to be arranged in a timely and appropriate manner. The introduction of Key Performance Indicators aimed to further enhance and consolidate discharge improvement processes. In addition, there was an emphasis on sustainability into the future and collaboration with GPs, other community providers, and patients and their carers.

In 2000 hospitals received a one-off, special purpose grant to ensure that all patients receive a hospital contact name and number on discharge to enable post discharge health advice.

2. Measuring Good Performance

In the first two years of the strategy, Patient Record Audits were conducted as a means of measuring and rewarding performance improvement. In 1998-99 and 1999-2000 hospitals were provided with bonuses for improvement in performance as measured against the results of the Patient Record Audits.

During 2000, a suite of indicators reflecting the phases of an effective discharge was developed and four of the five indicators were implemented in all acute hospitals, sub acute services and MPS on 1 st July 2001. The indicators incorporate the key processes of care for an effective discharge and aim to complement existing quality activities whilst maintaining relevancy for the majority of patients and healthcare organisations.

In 2001/02 health services were required to collect and report data against the performance indicators. All hospitals were required to undertake an audit of patient records in July 2002 for the purpose of assessing recorded evidence of compliance against the indicators. Hospitals used the Discharge Database supplied to hospitals by the department, to record and calculate compliance data. While the department undertook no further audits, many hospitals continue to use the database to monitor their own discharge performance.

3. GP/Hospital Integration Project

In 2000/01 the department, together with the Commonwealth Department of Health and Ageing, provided funding to General Practice Divisions Victoria (GPDV) to develop the GP Register - a database of GP names and contact details - with the aim of improving the transfer of information between hospitals and GPs. The register is available free of charge to all Victorian health care organisations. Over the coming year, the GP Register will be incorporated into the Statewide Services Directory.

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4. Enhanced Primary Care Demonstration Projects

In 1999, the Australian Government introduced the new Enhanced Primary Care Medicare Benefits Schedule (EPC MBS) items. The items compensate GPs for their involvement in discharge planning for their patients while they are in hospital. The department together with the Commonwealth Department of Health and Ageing and General Practice Divisions Victoria, sought to improve continuity of care for patients by using the EPC MBS items to improve linkages between public hospitals (including sub-acute inpatient services) and general practitioners in discharge planning and coordination. Four demonstration projects were undertaken commencing in November 2002. A final report - Involving GPs in safe referral home, A final report on four Victorian Enhanced Primary Care discharge demonstration projects, was produced and is available on the website.

5. Reviewing the Strategy

Over the course of the EDS, health services were funded to devise and implement changes in discharge practice and processes. By the end of the fourth year of the strategy it was expected that these changes would by then have had a systemic effect within each hospital. With one year of the strategy left to run, it was appropriate at that time to review the strategy’s progress to date.

The review found that there was a perception by staff in hospitals and community organisations that the strategy was successful in improving transition processes and practices. The EDS has heightened awareness of what constitutes good practice when transitioning patients from hospital back into the community and facilitated improved working relationships between staff within hospitals, between hospitals and between hospitals and the broader community. Respondents believed that the quality and safety of patient care improved as a result of the strategy. However, while there was acknowledgement that there have been improvements, there was a view that there is still more that needs to be achieved.

Other departmental initiatives such as Primary Care Partnerships, the Hospital Demand Management Strategy (in particular the HARP initiatives) and the Breakthrough Collaboratives continue to work with hospitals, community providers and GPs on discharge issues.

A final report - Transitioning care: a review of the Effective Discharge Strategy - details the findings from the review. It was released in May 2003 and is available for downloading from the website.

6. Good Practice Guide

Over the course of the strategy, hospitals developed many innovative and novel approaches to addressing gaps in performance their transition practices and processes. A guide for good practice for the transitioning of patients from hospital to the community was developed. This guide seeks to facilitate the sharing of achievements and is a resource tool for hospitals wanting to further improve their transition practices and procedures.

The guide, Improving patient transition from hospital to the community: a good practice guide, is available on the website.

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