576 / Work Instruction “The protected patients discharge in the hospital”

Type of Patient Safety Practice SAFE
Clinical Practice (CP)
Related practices from PaSQ database
“Best fit” category of the reported practice


Topic of the reported practice
Clinical guidelines or pathways
Aim and the benefit of the Patient Safety Practice
The objectives of this work instruction are: to clearly define the path of the protected discharge; to encourage and promote the appropriate use of this method of care; to plan the care pathway after the discharge, with an easy access for the patient; to avoid duplication of services or opportunistic behavior that may affect the clarity and quality of care in the post-discharge phase
Description of the Patient Safety Practice
The management of the patient during his hospital discharge is a crucial element in the success of every path-care hospital in the territory, because it ensures an appropriate and timely continuation of care in post-acute phase. Over the time, based on the integration and national and regional legislation updates on financial matters and management of discharge, coding systems specific for the discharge were introduced, in order to develop good behaviors that enhance a correct communication with the patient, to develop more effective and more appropriate care pathways, and to avoid opportunistic conduit. The purpose of this work instruction is to illustrate how to perform protected discharge as post hospitalization care pathway directly managed by the ward, especially in cases where the patient can be dismissed, but still needs cares related to hospitalization related diseases. Addressed to the Work Instruction Doctors of all hospital UU.00. of the ASL Roma B. The Protected Discharge (code 5) introduces a suspension of the initial hospitalization; this allows for the completion of the hospitalization where related diagnostic and therapeutic procedures only are carried out. This period is part of the hospitalization itself and lasts maximum 30 days. For all the examinations carried out under this regime, if linked to the cause of hospitalization, no ticket fee is due. Code 5 marked RAD card indicate the protected discharge and can benefit of a one month derogation with regards to the relevant medical history closure time and the subsequent data transfer to the Hospital Information System through the QUASIO online system, in accordance with ASP Directive October 1, 2010 Prot. 13093/ASP/DG and the DM 135/2010. In many cases, some of the control or final research activities can be carried out during the post-discharge phase, for a better use of available resources. This can be achieved by means of the patient accessing frequently under the regime of “protected discharge” for the necessary services within 30 days from the date of discharge. As envisaged in the circular of the Lazio Region prot. S1882/62 bis of 10/09/1997 “An access should be considered as protected discharge access (and the related services paid by the all-inclusive tariff related to hospitalization and not in shared-cost with the citizen) if programmed during the discharge, occurring within 30 days from discharge and completing the care pathway began with the admission “(i.e. return for removal of sutures, for a scheduled examination not performed during hospitalization for logistical reasons, etc..) or if is intended to complete the diagnostic / therapeutic pathway (i.e. specialist services such as visits, x-rays, casts removal, medication, etc. …. outpatient or hospitalization treated fractures shall also be considered). The activities are planned and requested by the medical staff of the ward during the discharge and should not be performed in specialist outpatient activities. All planned activity is charged to the requesting ward and corresponds to a single episode of hospitalization, variously articulated during time, and reimbursable by the flat rate of the entire episode of care attributed to the DRG. Any ambulance transport for non-ambulatory patients is also included. Its medial reports should be related to the Operative Unit or Service that supplied the care and will be included in the medical patient history. The above-mentioned programmed access do not require a new RAD to be opened. In these cases, the initial hospitalization is simply intended as suspended and the related RAD discharge card shall be closed only with the completion of the planned examinations, with the discharge date being the last day of actual hospitalization. The Health Department of ASL Roma B hospitals, together with the Scientific Committee for the management of the flow of information on clinical risk, will monitor the use of this work instruction through the data obtained from the SIO flow.
Attachment of relevant written information and/or photos, as appropriate
There is no specified text here
Effectiveness of the Patient Safety Practice
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Institution level
Specific and measurable outcome for the reported practice were defined
A baseline measurement before implementation of the reported practice was obtained
A measurement after full implementation of the reported practice was obtained
Evaluation of a “positive” effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Enclosure of a reference or attachment in case of published evaluation’s results
There is no specified text here
Health care context where the Patient Safety Practices was implemented
Successful implementation of this Patient Safety Practice in other health care settings than above stated
Specification of implementation in another health care setting(s)
There is no specified text here
Successful implementation’s level  of this Patient Safety Practice across settings
There is no specified text here
Involved health care staff
Clinical manager
Quality manager
Risk manager
Patient Involvement
Direct service user’s involvement as integral part of this Patient Safety Practice
Specification of the service users or their representatives’ involvement in the implementation of this Patient Safety Practice
There is no specified text here
Point of time in which service user or their reprasentatives’ involvement takes place
There is no specified text here
Active seeking of service users’ opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
There is no specified text here
Short description of the service users’ level of involvement
There is no specified text here
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
List of sources where public information is accessible
Implementation of the Patient Safety Practice
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
There is no specified text here
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
Regular data feed back to involved staff
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Costs of the Patient Safety Practices
Completion of cost calculation related to this Patient Safety Practice
Not relevant
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
There is no specified text here
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
There is no specified text here