In our latest Spotlight on local innovation blog, Dr John Day, consultant in general medicine, infectious and tropical diseases at Southend University Hospital, explores how criteria-led discharge (CLD) improves patient flow, enhances resident doctor training and empowers teams to make safe, timely discharge decisions.
This work was presented to the RCP president and senior officers during the RCP’s visit to Southend University Hospital in April 2025.
When I first started working on criteria-led discharge (CLD) more than a decade ago, my motivation was simple: discharge decisions were too often trapped inside consultants’ heads. We all carried a mental model of what ‘ready for discharge’ looked like, but it wasn’t written down, wasn’t shared consistently across teams and certainly wasn’t transparent to resident doctors, nurses or patients. Over time, it became clear that we needed a structured, standardised way to articulate what safe discharge meant – not just for us, but for the whole multidisciplinary team.
CLD grew from that recognition. At its heart, it offers a way of breaking down readiness for discharge into visible, measurable criteria that everyone can understand. Rather than vague statements like ‘improving’, we define exactly how well a patient needs to be before they can safely go home (eg not requiring supplementary oxygen for a defined period of time, corrected potassium to target level, infection markers declining). This shifts discharge from a mysterious consultant decision to a shared, trackable process.
One of the most important shifts that we made was deciding to set discharge objectives at the point of admission. That means working backwards from the desired end point, rather than responding reactively as the admission unfolds. Consultants and senior doctors translate that end point into specific, measurable criteria and document them electronically. The patient’s progress is visible at every board round and updated daily.
This approach brings a level of continuity and alignment that we had been missing. Patients often see multiple clinicians during a short admission and CLD ensures that everyone is aiming for the same, clearly defined goals. For residents, it provides a practical framework for understanding discharge planning and helps them to focus on the interventions that genuinely move a patient closer to going home.
Our early CLD sticker system noticeably improved weekend discharge rates by making goals more visible. Moving to electronic tracking has taken that improvement further, allowing consultants, nurses and allied health professionals to review patient progress at a glance.
One comparison suggested shorter lengths of stay, although collecting robust data remains a challenge, not least because discharge planning is influenced by so many external factors. Still, anecdotal and qualitative feedback continues to be strong.
The data that we do have are illuminating. CLD has helped us to identify the most common causes of delayed discharge: tracking response to antibiotics, oxygen weaning, and waiting for procedures or specialty input. Understanding these patterns gives us a starting point for broader improvement work. And, importantly, patients and families repeatedly tell us how reassuring it is to see their discharge goals defined and communicated openly.
Despite its benefits, CLD has not been universally adopted across teams. Like any change that touches clinical practice, success depends heavily on consultant buy-in, nursing engagement and reliable twice-daily board rounds.
Resident doctors may lack confidence in defining discharge criteria. Conversely, consultants can be reluctant to delegate discharge sign-off to nursing staff, even when criteria have been fully met. Both behaviours highlight the cultural work that is still needed and the importance of education, modelling and trust. Sustaining CLD also requires ongoing commitment to training and IT support. This isn’t a tool that you can implement once and walk away from; it needs nurturing, reinforcement and visible leadership.
For me, one of the most exciting aspects of CLD is its educational impact. It helps residents to think systematically about discharge, not as an abrupt moment when a consultant decides that someone can go home, but as a process of reaching clearly defined, evidence-based goals. It teaches risk assessment, communication, teamwork and shared decision-making in a way that abstract teaching sessions rarely can.
Our experience shows that structured discharge planning can improve patient flow and experience, and the training environment for resident doctors. The next phase of our work will focus on expanding CLD further, developing a more robust dataset and sharing our learning with other trusts that want to adopt a similar approach.
CLD has helped us to demystify one of the most critical aspects of acute care. And as we continue to refine it, I’m confident that it will contribute to safer, more consistent and more patient-centred discharge planning across our organisation.
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Dr John Day
Consultant in general medicine, infectious and tropical diseases at Southend University Hospital
