The implementation of Complex Discharge Rounds across both sites of Middlesex Hospital Alliance began in March 2017.  These weekly rounds were established as a forum to discuss discharge plans for both complex and ALC patients.  Prior to this time ALC discharge rounds were held monthly with little to no impact on patient flow.  The changes we implemented were the establishment of a weekly time for the round, a pre circulated list of patients to be discussed and the expectation of attendance from hospital staff, which is the multidisciplinary team, and Home and Community Care.  There is also an expectation that either hospital staff or Home and Community Care staff will identify patients who require discussion and discharge planning.  This improvement has been successfully sustained for over 20 months and is led by our Quality Improvement Specialist.  Patients and families are actively engaged throughout the discharge planning process in determining goals for discharge, services and supports required and timing of discharge.  Patient and family input is discussed at the bedside in advance of the Complex Discharge Rounds to enable an action oriented discussion to occur at the Rounds.  This discussion is then brought back to the patient and family to ensure transparent and timely discharge planning and discharges to the most appropriate destination.

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