Our new role in the Board Round – the principle of discharge planning from earliest opportunity

By Rachael Hardbattle

In most hospitals, the Board Round has been introduced, which is very different in scope and aims from the long established Ward Round. Everyone will be familiar with the ward round – a group led by a consultant, with junior doctors, nurses and other healthcare professionals, moving from patient to patient. The aim is to review each patient’s progress and update the care plan as required.

A notable difference with the Board Round is that it usually will not take place around the patient’s bed. The multi-disciplinary team gather around a visual management board highlighting key information about the patient, including diagnosis, admission date, care management plan and expected date of discharge.

The aim of the Board Round is to ensure momentum towards discharge is maintained. Discussions may include non-medical tasks, such as communications required with family members and community or social care providers for discharge to take place.

One of the main advantages of the Board Round is that it provides an opportunity to pool information so that everyone is aware where any patient stands from the perspective of all the different departments and specialties involved in the discharge process. In doing this, discharge planning maintains momentum, any potential hiccups can be identified and plans put in place to resolve issues early on.

We have twenty years of experience in discharge planning. One or two decades ago, we would be referred patients at the point when they were medically fit for discharge. Now, there is widespread recognition that discharge planning needs to start much earlier, indeed from the moment a patient enters hospital.

For example, at hospitals in Southampton and Burton, we run a service specifically for patients who are admitted to hospital from a care home. Recognising that these patients can face long delays to discharge while their community care is organised (for example, they may need to move from a residential to a nursing home), we provide additional support right from the point of admission. This may include liaising with their care home to ensure their assessments take place in a timely way, or starting the process of finding a new home with a higher level of support at an early stage, rather than waiting to do this until the patient is medically optimised.

At hospitals in the East Midlands, Cambridge and the west country, we are now taking part in the Board Round. There is a clear rationale for this – it is extending the principle of ideal, early discharge planning to all elderly, frail patients, not only those being admitted from a care home. Also, being present during Board Round, we can ensure ensures the CHS service is available to everyone on the wards. Board Round is a very valuable opportunity to identify all patients who may benefit from discharge support at an early stage.

Our staff have a clearly defined role and responsibility at Board Round – all the non-clinical tasks required to facilitate discharge are theirs to fulfil. They must accomplish these tasks in a timely way and report back. Unlike clinical staff with other responsibilities, our staff are able to focus wholly upon discharge planning and have special training in the personalised family work required when choosing a care home, for example.

From our perspective, there is a real benefit in having a role in the Board Round in this way. The key professionals we need to liaise with are present; no time is lost making phone calls to the team and chasing information. It is still early days for this relatively new role and approach, but it is very promising, putting into practice all the best principles of early discharge planning.