As we enter a new year of operational planning and guidance for the NHS, improving A&E waiting times and ambulance response times remains a key priority. By March 2026, at least 78% of patients must be admitted, discharged, and transferred from the ED within four hours.
Using the four-hour emergency access standard as the key criteria for monitoring patient flow implies that success in patient flow is the responsibility of the Emergency Department (ED). However, to truly optimise patient flow, improvement initiatives must go beyond the ED.
Improvement activities that assist patients in receiving timely hospital discharges can and should make a major contribution to increased flow.
One of the initial challenges when identifying opportunities for improvement to timely discharge for patients is that, unlike ED metrics, there is often less clarity on what the core set of metrics and targets are. Recording of key discharge metrics can also be inconsistent, and, as the language used to describe patients who no longer need to be in an acute inpatient bed continues to change, it can be unclear what data needs to be recorded.
A shared understanding by staff of discharge language and targets is key to ensuring its correct use and that the data is recorded accurately and consistency. This also needs to be supported by digital systems that need to provide an efficient and succinct solution to capture information relevant to a patient’s discharge pathway, otherwise staff have to use manual workarounds that contribute to even greater inconsistencies.
If we can break the cycle of data inaccuracy and inconsistency, then we can better understand and determine which initiatives will effectively enhance patient flow. In turn, we can build plans and gain traction that will positively impact the teams in ED, which for patients on the emergency care pathway is critical.
What we know, is that there are some fundamental principles for successful patient flow on inpatient wards and that implementing these principles will assist patients’ timely departure. The accurate capture of discharge information and the understanding of what good looks like for individual trusts or hospitals are key enablers to embedding these principles.
Key principles for patient flow
Effective use of Board Rounds for a shared understanding of the next steps for discharge: One of the fundamentals of this approach is improving the understanding of whether a patient still needs to be receiving care in the hospital and, if not, identifying the reason for the delay (internal or external) and taking action to mitigate these.
Example: using best practice board round guidance to develop an exemplar board round approach that is rolled out across all wards. This will include the capture of key information to support discharge planning.
Driving a focus on reducing long lengths of stay: Ensuring there are processes in place for an action-focused review of patients with a long length of stay.
Example: implementing over 7-day LOS meetings with appropriate clinical and operational input to provide advice and guidance for wards for their patients with a longer length of stay.
Prioritising discharges earlier in the day: Encouraging a focus on patients being home for lunch will benefit those patients who are waiting in other areas of the hospital to receive inpatient care.
Example: implementing over 7-day LOS meetings with appropriate clinical and operational input to provide advice and guidance for wards for their patients with a longer length of stay.
Having clear processes for escalation of delays for patients: If delays that are identified can be quickly managed through effective escalation processes, this will reduce the time a patient waits in the hospital when they do not need to be there.
Example: Ensuring that there is an agreed set of internal professional standards (IPS) that triggers an escalation process, and ensuring that there is a tested process for both internal and external delays in place.
Positive impact on all patients
A single timely discharge will benefit the patient, but will also have a positive impact on many other patients across the UEC pathway. Figure one is taken from a concept by NHS COO Ned Hobbs (2024) highlighting the five patient types who benefit from a timely discharge.
As the NHS embarks on a new year of operational planning, a comprehensive approach is needed that extends beyond the ED.
Enhancing hospital discharge processes is crucial for optimising patient flow, and by implementing key principles hospitals can significantly improve discharge efficiency. Ultimately, timely discharges not only benefit individual patients but also enhance the overall patient experience across the urgent and emergency care pathway, thereby fostering a more efficient healthcare system.
About Katie Johnstone
As a Delivery Director at Prism Improvement, Katie’s role is to oversee the successful delivery of all of the urgent & emergency care improvement programmes.
Katie has a background working in health and social care consulting and for the NHS, both with the aim of delivering improvements to a patient’s care journey on an urgent care pathway, with a particular focus on discharge pathways for patients leaving acute hospitals.
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