LR13 / Clincal Risk Management (CRM) Practice on Discharge Planning

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


Patient safety theme the SCP/clinical risk management practice is aimed at
Discharge planning (flow chart)
Objective of the CRM practice
To establish if the discharge guidelines requiring patients to have a caregiver in the home with them for the first 24 hours following endoscopic procedures were neccessary. Due to the lasting effects of moderate sedation, gastrointestinal investigations carry a degree of risk including adverse events from sedation. But, independence is very important to the elderly population who do not want to bother anyone to stay with them for 24 hours following thier procedure, therefore posing a significant risk.

Majority of patients were not meeting the Australian and New Zealand College of Anesthetists Recommendation that there must be a responsible adult with the patient for at least 12 to 24 hours following a procedure.[7]

Short description of the CRM practice, including any references for further information
To assure that guidelines for discharge planning promoted optimal patient safety following endoscopic procedures. A flow chart was designed to include discharge planning at the time of referral, immediately preprocedure and postprocedure.[1]
Innovator of the SCP, country of origin
Adelaide, South Australia
Involved health care staff
Tested in which countries/health care systems, health care context(s) and/or clinical specialty/specialties, including references
General hospital/ endoscopy
Summary of evidence for effectiveness, including references
A post procedure telephone survey assessed if patients were safe at home, pain and comfort levels, and if patient could manage without their caregiver. Results suggests that planning and reviewing guidelines for patient discharge post endoscopically significantly reduced potential problems and promoted safe practice for patients post procedure.[1]

A systematic review concluded that heart failure patients were less likely to be readmitted to hospital in the six months after discharge in case management interventions where patients were intensively monitored by telephone calls and home visits, usually by a specialist nurse; clinic interventions involving follow-up in a specialist clinic; and multidisciplinary interventions[2]. Telephone discharge follow-up has been assessed in a variety of health care settings in different countries [3-6].

Summary of evidence for transferability (transferability across health care systems or health care contexts or clinical specialties), including references
Summary of available information on feasibility, including references
Structure of modern society, work and family committments or geographical barriers often makes it difficult for some patients to have a relative or friend close by.
Existing implementation tools, including references
Australian and New Zealand College of Anesthetists Recommendations for Day Surgery[7]
Potential for/description of patient involvement in the CRM practice, including references
The patient or responsible person must understand the requirements for post anaesthetic care and comply with them.
Bibliography (for each reference: author(s), year, title, journal/internet link, page(s))
[1] Gall S, Bull J (2004) Clinical risk: discharging patients with no-one at home. Gastroenterol Nurs 27:111-114

[2] Takeda A, Taylor SJ, Taylor RS, Khan F, Krum H, Underwood M (2012) Clinical service organisation for heart failure. Cochrane Database Syst Rev 9:CD002752

[3] Colmont D (2012) [The benefit of the telephone questionnaire the day after outpatient surgery]. Rev Infirm33-34

[4] Yang C, Chen CM (2012) Effects of post-discharge telephone calls on the rate of emergency department visits in paediatric patients. J Paediatr Child Health 48:931-935

[5] Young J, Harrison J, Solomon M, Butow P, Dennis R, Robson D, Auld S (2010) Development and feasibility assessment of telephone-delivered supportive care to improve outcomes for patients with colorectal cancer: pilot study of the CONNECT intervention. Support Care Cancer 18:461-470

[6] Hanssen TA, Nordrehaug JE, Eide GE, Hanestad BR (2007) Improving outcomes after myocardial infarction: a randomized controlled trial evaluating effects of a telephone follow-up intervention. Eur J Cardiovasc Prev Rehabil 14:429-437

[7.] Australian and New Zealand College of Anaesthetists. Recommendations for the perioperative care of patients selected for day care surgery. 2000. 7-2-2013.

Any additional information on the CRM (e.g. implementation barriers and drivers)