The change

An initial test demonstrated that locating more discharge coordination resource on wards made a significant positive difference to discharges. The PSC then supported the ICT to review its ways of working in full and develop a business case for investment to transform. Together, the ICT and The PSC conducted a Time In Motion study, shadowing roles across the team to identify waste and potential efficiencies, and surveyed staff to highlight areas for process improvement. Informed by this analysis, the ICT made the following key changes during a pilot that ran from October 2024 – March 2025:  

• Increased resources in the ICT and co-located CDT team members on the wards they worked with, rather than in a central hub (this required investing in laptops and mobile devices for the team).
• Assigned RAG ratings to all wards based on complex discharge activity, prioritising red and amber wards with increased ICT team presence.
• Recruited and deployed Band 4 Discharge Coordinators and Therapy Assistants at the front door to optimise workflow and free up Band 6 clinicians’ time for admission avoidance.
• Discontinued prioritising discharge planning based on Clinically Fit Date, as frequent changes made it unreliable, and adopted the more consistent ‘Medically Ready for Discharge Date (MRD)’ in alignment with Criteria to Reside guidance.
• Streamlined EPIC documentation through a bespoke Discharge Coordinator ‘Levelling Up’ programme.
• Defined and communicated clear roles and responsibilities for team members and Patient Flow Coordinators.
• Created a dedicated dashboard so that the pilot’s impact could be monitored and communicated clearly week to week and month to month.

The pilot radically reduced discharge delays in all the wards involved and delivered c. £500,000 of financial benefit over 90 days by saving 18 beds. 

The impact

Patient impact:  

In admission avoidance:  

• The number of EIT admission avoidances grew from 25 in October to 114 in March. By March, an average of four admissions were avoided each day.

In getting people home faster:  

• Wards involved in the pilot reduced the average number of NCTR patients each day by over 50% (an average of 31 NCTR per day down to 13 NCTR per day by the end of the pilot). 
• The pilot showed the biggest improvement in reducing long length of stay, demonstrating a 4.41% reduction in the number of people staying 21+ days.  

Financial impact:  

• The pilot returned £3 for every £1 invested due to saved bed days, more than paying for itself in terms of the investment in additional staffing, equipment and transformation support.   

Efficiency impact:  

• The improved discharge notification form reduced admin time by 60%.

Impact on ward staff:  

• 92% of ward staff reported improved coordination and communication between teams and 78% of ward staff said they felt more supported in managing complex discharges.

Key learnings in reducing internal discharge delays  

Internal discharge delays can be significantly reduced by streamlining operational processes within the organisation, including workflows, staffing models, capacity and demand analysis, and applying quality improvement methodologies. By uniting the entire teams around a clear, shared goal of demonstrating improvement through the pilot, we fostered motivation and inspired meaningful change, leading to additional investment in both teams to ensure sustained delivery. 

The team’s next steps are to embed and sustain the changes, reduce delays in Pathway 3 and End-of-Life fast-track discharges, and strengthen collaboration with wider system partners to deliver a true ‘Discharge to Assess’ model and address external delays.  

If you'd like to find out how The PSC can support you to run a similar Time in Motion study and pilot to improve operational processes and reduce discharge delays, or wider patient flow and discharge model support, get in touch with Chris Bradley at Chris.Bradley@thepsc.co.uk.