Safari discharge: improving the efficacy and accuracy of discharges from the hospital, leading to improved patient safety and patient flow
Authors: Newell E , Cullen K , Akram H 
Published: November 2022

Abstract

Introduction
The discharge process at Calderdale and Huddersfield NHS Foundation Trust (CHFT) has been inefficient, resulting in delayed discharges and increased prescription errors. Ultimately this impacts on patient safety, satisfaction and places pressures on the trust. A recent study1 showed how in one trust, implementation of Pharmacy within the discharge process, by writing prescribing and dispensing discharge paperwork and items on the wards, significantly reduced discharge times. We hoped to mirror this at CHFT with the implementation of the ‘Safari discharge team’ (SDT). The team model consists of a prescribing pharmacist, a pharmacy technician and a Physicians associate.

Aim
To speed up discharge processes once a patient has been declared as medically fit, reduce the number of errors on ‘to take out’ (TTO) prescriptions and free up nurses’ time by allowing the ‘SDT’ to complete patient locker checks.

Methods
Baseline data was collected from patients TTO prescriptions that come into the Huddersfield Royal infirmary (HRI) pharmacy dispensary between 15/11/21-19/11/21. Data was recorded using a specialised data collection form. A second data collection form was given to the SDT when the team went live at HRI (15/12/21). This was completed for all patients referred to them. Both forms included time stamps for when the patient was medically optimised for discharge (MOFD), when the TTO prescription was dispensed and when patient was discharged. We also recorded the number of TTO prescriptions containing errors. All information gathered was transcribed onto an excel document for analysis. Ethical approval was not required for this quality improvement initiative and service evaluation.

Results
From 15/12/21-04/04/22 the SDT processed 824 patients. Of these, ≈585 patients were discharged the same day. Overall patients were discharged 5 hours and 15 minutes faster, freeing up 8.6 hospital beds/working week. Error rates on TTO prescriptions reduced from 50% to 1.37% when written by a pharmacist on the SDT. Typically, 63% of patients referred had a locker check completed by the SDT. This task takes a nurse 9.4 minutes to complete. Completion by SDT freed up 5.4 hours per working week.

Discussion/Conclusion
Unfortunately, a large percentage of patients did not go home after being seen by the safari team. This was due to patients being readmitted, awaiting care, transport or the TTO was done in advance of planned departure. Although not articulated in these figures, completing TTOs in advance would increase speed of discharge later down the line. Implementation of the safari team has freed up hospital beds, increasing patient flow through the hospital. This project has also shown that a pharmacist’s involvement in the discharge process reduces errors on discharge letters, ensuring patients are sent home with safe and correct medication. The SDT has successfully been able to replicate the positive influence on discharges found by the trust where the initiative was derived from. We hope to continue the project at CHFT to benefit more patients across the site. The next step would be to disseminate the results found here to initiate other trusts to pilot a pharmacy discharge service and compare data and results.

References
1. Physick, A., Smolski, K., Mann, S., Price, G. Pharmacy innovation at discharge - impact of pharmacist non-medical prescribing on quality and streamlining processes. Journal of Medicines Optimisation, 2022;2(1):6.