Medication change not propagated
Action: Assign the accountable downstream service, preserve source conflict, reconcile local workflow, acknowledge closure.
Proof: Time-to-close, unresolved discrepancy rate, obsolete supply prevented, safety.
Intervention intelligence
Every signal needs an owner, a governed action and a measurable close.
Sitora does not treat detection as success. Each product has its own intervention logic, safety boundary and proof of completion.
Product action model
Different problems require different interventions.
Repeat may not be needed
Action: Present the oversupply/stock/change signal for human review before dispensing.
Proof: Reviewed signals, deferred supply, workload, missed-needed-supply rate, verified cost avoidance.
Necessary treatment uses high resource
Action: Compare clinically appropriate alternatives, approve locally, measure before/after pathway resource.
Proof: Staff minutes, chair/bed time, unused dose, patient impact, validated financial effect.
Core rule
No intervention counts because a notification was sent, a flag was generated or a pathway was modelled. The relevant downstream action and outcome must be observed.
Measurement chain
Four tests before benefit is claimed.
1Signal
Problem validated
Is the discrepancy, supply risk or resource opportunity real?2Action
Owner acted
Did the responsible professional or service complete the governed action?3Outcome
Workflow changed
Was the medicine state, dispensing outcome or treatment pathway actually different?4Value
Benefit classified
Safety, cash, avoidance and capacity remain separate.Legacy discharge and wider NHS intervention library
These remain supporting research and future expansion opportunities rather than current Sitora medicines products.
Community rehabilitation and reablementResearch 1
Signal: Largest national LOS 7+ reason group in the August 2026 acute discharge dataset.
Owners: ICB · Community provider · Local authority · Acute trust
Intervention: Create a single visible pathway 1 and pathway 2 demand-and-capacity view, use Home First and discharge-to-assess as the default where clinically appropriate, and match referrals to available rehabilitation or reablement capacity before delays accumulate.
Verification: Use a pre/post or stepped local comparison with DRD as the denominator. Separate pathway 1 and 2 effects and adjust interpretation for changes in discharge volume and case mix.
Hospital discharge processResearch 2
Signal: Hospital-process reasons represent a material share of the LOS 7+ reason series and dominate some providers.
Owners: Acute trust · Clinical divisions · Pharmacy · Therapy · Patient transport
Intervention: Run criteria-led discharge with early expected discharge dates, twice-daily review of patients who no longer meet criteria to reside, and a same-day exception queue for outstanding medical review, therapy, medicines, documentation and transport.
Verification: Use timestamped task data to show that the targeted internal dependency shortened before attributing any change in bed days to the intervention.
Residential or nursing placementResearch 3
Signal: Residential and nursing placement is one of the largest national coded reason groups and dominates several high-delay providers.
Owners: Local authority · ICB · Care transfer hub · Care providers · Acute trust
Intervention: Create a live placement marketplace at system level showing required care level, funding status, referral state, provider response and realistic availability, with daily escalation of long waits and out-of-area options where appropriate.
Verification: Compare delay stages before and after the intervention. Attribute improvement only where the specific placement stage shortened, not from overall discharge movement alone.
Care transfer hub processResearch 4
Signal: Care-transfer-hub process is a major national reason group and the dominant signal for several providers.
Owners: ICB · Care transfer hub · Acute trust · Local authority · Community provider
Intervention: Operate one cross-system discharge queue with named case ownership, complete referral information, agreed triage rules and visible ageing so no patient waits because responsibility is unclear.
Verification: Require timestamp evidence from the shared queue. Improvement should be visible first in referral handling and case ageing, then in DRD delay.
Home care and package of careResearch 5
Signal: Home-care/package-of-care delays account for a substantial share of the national reason mix and can trap pathway 1 patients in hospital.
Owners: Local authority · ICB · Home-care providers · Care transfer hub
Intervention: Match required visit patterns and geography to real provider capacity, distinguish commissioning delay from workforce shortage, and use short-term bridging or reablement capacity where locally approved and clinically suitable.
Verification: Link each released bed day to a completed package start or approved bridge arrangement and continue follow-up to ensure the discharge remained sustainable.
Funding and approvalResearch 6
Signal: Funding/approval is smaller nationally than the largest capacity groups but creates avoidable administrative delay in individual systems.
Owners: ICB · Local authority · Care transfer hub · CHC teams
Intervention: Make funding status visible early, use agreed decision thresholds and escalation routes, and remove repeated information requests where the required evidence already exists.
Verification: Demonstrate shorter decision-cycle time and then assess whether that translated into earlier service start or discharge.
Equipment and housingResearch 7
Signal: A smaller national share can still create long individual waits, especially where adaptations or specialist equipment are prerequisites for safe discharge.
Owners: Local authority · Community equipment service · Housing · Occupational therapy · ICB
Intervention: Track equipment and adaptation dependencies from identification to delivery, use standard equipment bundles where appropriate, and escalate housing cases separately from equipment cases because their lead times differ materially.
Verification: Only attribute recovered time where the relevant equipment or housing dependency completed earlier than baseline.
Patient, family and safeguarding concernsResearch 8
Signal: These reasons are less common nationally but can generate complex and prolonged individual delays.
Owners: Acute trust · Local authority · Safeguarding teams · Care transfer hub · Patient and carers
Intervention: Start shared decision-making early, identify capacity or safeguarding questions promptly, document the unresolved issue precisely, and use senior multidisciplinary review for long-running cases.
Verification: Use qualitative case review alongside time metrics. These cases should never be judged on speed alone.
Patient transportResearch 9
Signal: Transport is a smaller national cause but can be highly actionable because request, booking and pickup timestamps are measurable.
Owners: Acute trust · Patient transport provider · ICB
Intervention: Predict transport needs earlier, book against an expected discharge window, separate eligibility from availability failures, and monitor late cancellations and missed pickups.
Verification: Use timestamped transport data and count only delays where transport was the final unresolved dependency.
Closed-loop repeat medicines
Repeat supply can continue despite excess stock, discontinuation, dose changes or weak reconciliation.
Intervention: Join prescribing, dispensing, expected consumption, medication changes and patient or pharmacy confirmation before the next supply decision.
Ready-to-administer conversion
Nursing and pharmacy time is consumed preparing injectable medicines that may have a suitable ready-to-administer presentation.
Intervention: Identify clinically suitable products where licensed or approved ready-to-administer supply can replace local preparation.
IV to subcutaneous route optimisation
Patients may remain on resource-intensive IV pathways after a clinically suitable subcutaneous option becomes available.
Intervention: Continuously compare route, eligibility, pharmacy preparation burden, chair time and total pathway cost.
Dose banding and advance preparation
Patient-specific preparation can prevent batching, create delay and increase the risk of unused preparations.
Intervention: Use nationally supported standardised dose bands where clinically appropriate and measure the effect on production, waiting and waste.
Image-first specialist triage
Specialist appointments can be consumed before high-quality visual information has been captured and reviewed.
Intervention: Capture standardised images in an appropriate community setting and route suitable cases for remote specialist review before outpatient booking.
School and community dental detection
Preventable decay may only enter the system after progression to more expensive treatment.
Intervention: Test scheduled structured checks, supported imaging where appropriate, and defined escalation to qualified dental review.
Detection creates an obligation to investigate. Only a completed, safe and measured downstream action creates evidence of value.