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Barriers to effective discharge – breaking the bottleneck

A project run in Whipps Cross University Hospital, Barts Health NHS Trust

Related themes

  • Out of hours care (24/7)
  • Front door/ A&E


Professor John Collins’ Foundation for Excellence report highlighted that doctors in training lack knowledge regarding discharge processes, care in the community and interdisciplinary team working, yet often have to make decisions regarding patient discharge.  The aim of this project was to implement a sustainable teaching programme based on educational theory that would create a cultural change within trainee doctors, promote an active role in the discharge process and streamline patient flow.

Project objectives

  • Train non-technical skills and team working in an inter-disciplinary environment.
  • Ensure sustainability and adoptability of the project on a national level.
  • Give formal training to trainees in the discharge process and patient flow issues
  • Encourage senior clinical staff to impart their experiences to junior doctors and learn how to overcome issues.
  • Overcome the barriers to inter-disciplinary team working which cause unsatisfactory delays in patient discharge.

Who was involved

The project was managed by two trainee doctor leads, one at each project site. Each hospital site also had a senior clinician lead overseeing the project. The foundation programme director and administrative staff ensured sessions took place within allocated teaching slots.


  • Raised awareness of the complex nature of patient discharge among trainees.
  • Highlighted the fundamental role that trainees play and allowed them to consider patient’s social needs, facilitated interaction with other team members and consolidated the importance of optimal communication between secondary care and primary care.
  • Highlighted to trainers the optimal teaching format and content to target trainee needs which included short sessions, case based, interactive and physician led.
  • Improved patient satisfaction through raising awareness amongst trainees about the needs of patients – including personal, medical and social requirements.
  • Improvement in efficiency of transitioning patients from secondary care to primary care.
  • Increased awareness of issues and an overriding responsibility for communication with primary care has reduced patient safety incidents and optimised efficiency in care.

What they’ve said

“I think the way you’ve organised it has been good … it’s been very interactive and I think it’s introduced us to all the essential components in discharge planning.” 


“I think running through the cases was quite useful, it was quite a good session in terms of being an interactive session, quite hands on which I think helps reinforce them.” 


“It’s all been quite comprehensive actually and you’ve had a good mix of lecture based discussions and group discussions and you’ve had members of the whole MDT come in and talk to us…  it’s good to hear from every angle of discharge planning as well and I think you’ve organised it well.” 



Please look at the materials in the toolkit. The top tips and business cases have been developed by the BTBC team to support organisations to implement these changes and the case studies and project resources have been developed and approved by the project teams.

Business case
Case study
Top tips

The top tips include lessons learnt that have been identified throughout the project. The business case will guide you through the management principles and communications and engagement activities. The case studies provide a detailed overview of the project. Feel free to adapt these resources to suit your projects.
Your organisation may have its own materials and templates that you can use or you may find the NHS Improving Quality (NHS IQ) learning handbook useful too.

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