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Strengthening discharge planning and patient flow at James Paget University Hospital
James Paget University Hospital partnered with Xyla to improve the discharge process for patients who were medically fit to leave hospital but required coordination with current care homes or existing care providers. Through focused operational support, proactive communication and daily ward engagement, Xyla helped reduce delays and improve visibility of discharge readiness.
Key outcomes
464 Pathway 0 patients supported
267 patients discharged back to their existing care home or agency
376 discharges supported in total
Medically fit to discharge length of stay reduced from 1 day 18 hours to 16 hours.
The challenge
James Paget University Hospital faced increasing pressure to discharge Pathway 0 (P0) patients efficiently. Patients returning to care homes or needing to resume existing care packages were a particular focus.
As these decisions sat outside the hospital, essential information was not always available at the right time to support smooth discharge planning. Coordinating with multiple providers created challenges in how quickly updates were received, making it harder for ward teams to maintain a clear, consistent view of discharge readiness and sometimes contributing to longer hospital stays.
Why Xyla
James Paget chose Xyla because of our experience supporting discharge pathways and our ability to introduce simple, practical processes that complement existing clinical work. Our clear operational model gave the hospital confidence that we could help them build consistency, strengthen communication with external partners and reduce avoidable delays.
The solution
Xyla worked with James Paget University Hospital to introduce a structured approach to Pathway 0 discharge support, improving communication, visibility and daily workflow. This began with a proactive model for contacting care homes, domiciliary providers and next of kin. Each day, the Xyla team confirmed provider capacity, shared expected discharge dates and recorded all updates in Optica, giving ward teams an accurate real time view of discharge readiness.
Xyla’s team also visited the wards daily to identify P0 patients, provide provider updates and support discharge discussions. This created a consistent flow of information and helped ward teams plan confidently and efficiently.
Impact
Improved discharge flow and reduced backlogs
Xyla supported 464 P0 patients, including 267 discharged back to their care home or agency, leading to 376 completed discharges. This increased capacity helped the hospital manage demand more effectively and reduced delays linked to external care providers.
Faster discharge for medically fit patients
The medically fit to discharge length of stay improved consistently, falling from 1 day 18 hours in September to 16 hours in January. This reflects a more efficient process once patients were clinically ready to leave hospital.
Stronger resilience and smoother coordination
Daily ward presence and proactive communication helped maintain continuity of care during busy periods. Xyla made 1,303 calls to care providers, 1,909 to wards and discharge teams and 392 to next of kin, ensuring timely, accurate information for safe discharge planning.
Smoother discharge journeys and better patient experience
Smoother discharge journeys improved outcomes and a better patient experience supported by clearer ward processes enhanced communication with next of kin and faster coordination with care homes. Xyla supported 25 self‑funding referrals and placed 19 patients with a median time of 4 days 23 hours saving up to 2 days 4 hours.
For other referral groups Xyla saved an average of 1 day 15 hours per discharge for P1 referrals and 24 days 14 hours per discharge for P3 discharges.
Contact our patient flow and community transition team
If you are looking to improve flow and embed sustainable discharge routines in your organisation, Xyla can help. Contact us to explore how we can support your hospital or system.
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