Discharge from hospital: pathway, process and practice

GREAT BRITAIN. Department of Health. Health and Social Care Joint Unit and Change Agents Team
Great Britain. Department of Health
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This good practice guidance updates and builds on the Hospital Discharge Workbook published in 1994. The Government Response to the Health Select Committee Report on Delayed Discharges, issued in November 2002, indicated that the workbook would be updated to reflect the Government's commitment to tackle delayed discharges in line with its commitment in the NHS plan.

Extended abstract:

GREAT BRITAIN. Department of Health.


Discharge from hospital: pathway, process and practice.


Great Britain. Department of Health, 2003


This good practice guidance updates and builds on the Hospital Discharge Workbook published in 1994.


The Government Response to the Health Select Committee Report on Delayed Discharges, issued in November 2002, indicated that the workbook would be updated to reflect the Government's commitment to tackle delayed discharges in line with its commitment in the NHS plan.


A foreword by the Minister of State declares that a dmission to and discharge from hospital can be a distressing time for individuals, their families and friends. For most people, however, treatment will be successful and they will return to their usual way of life very quickly through the provision of an accurate diagnosis, treatment and rehabilitative service. Some people will need additional help to enable them to do so over and above their medical treatment. These needs can be many and varied and cannot be met by the NHS alone. It is increasingly evident that effective hospital discharges can only be achieved when there is good joint working between the NHS, local authorities, housing organisations, primary care and the independent and voluntary sectors in the commissioning and delivery of services including a clear understanding of respective services. Without this the diverse needs of local communities and individuals cannot be met. Government policy and recent legislative changes aim to help one work more creatively across the traditional organisational boundaries. This workbook, primarily concerned with the care of adults with physical ill health, has drawn together some of those examples of good practice to assist commissioners, practitioners and managers in their efforts to improve the processes of discharge planning. It recognises the importance of close working between specialist mental health and learning disability services, and that many of the principles and practices will apply equally to younger adults and children, although further guidance on these will be issued separately. Its key messages are: understand the local community and balance the range of services to meet health, housing and social care needs; ensure individuals and their carers are actively engaged in the planning and delivery of their care; recognise the important role carers play and their own right for assessment and support; ensure effective communication between primary, secondary and social care to ensure that prior to admission and on admission each individual receives the care and treatment they need; agree, operate and performance manage a joint discharge policy that facilitates effective multidisciplinary working at ward level and between organisations; on admission, identify those individuals who may have additional health, social and/or housing needs to be met before they can leave hospital and target them for extra support; at ward level, identify and train individuals who can take on the role of care co-ordination in support of the multidisciplinary team and individual patients and their carers; consider how an integrated discharge planning team can be developed to provide specialist discharge planning support to the patient and multidisciplinary team; ensure all patients are assessed for a period of rehabilitation before any permanent decisions on care options are made; and ensure that the funding decisions for NHS continuing care and care home placement are made in a way that does not delay someone's discharge. The workbook provides guidance and practical tools in a way that allows one to focus on those areas that present challenges at a local level. It also directs to other sources of information and websites where useful advice can be obtained that will help achieve improved outcomes for individuals and meet performance targets. A list of useful abbreviations and a glossary precedes the core of the book, in seven chapters. An i ntroduction and overview discusses d elayed transfer of care, improving discharge performance, government policy, key principles and how to use the workbook. Background information on policy context covers r ights and responsibilities, service standards and future service developments. Developing a 'whole system approach' asks w hat are the characteristics of whole system working and who is included and considers whole system working for effective hospital discharge, the contents, characteristics and components of a good inter-agency discharge policy, and action steps, giving a practical example, and has appendices on supporting the system, transport, and a discharge planning self-assessment tool. i nvolving patients and carers gives an overview of the issues, key features to achieve successful involvement, assessing need and action steps, with practical examples and appendices consisting of a carer's assessment checklist, carer's assessment and care plan, and a patient's and carer's leaflet. The longest section, on co-ordinating the patient journey, covers an overview of the key issues, the patient journey, pre-admission assessment, admission to the ward, equipment provision, discharge lounges, and transport, with an action plan. practical examples, discussion of multidisciplinary and inter-agency teamwork, and appendices on medicines management, a discharge checklist, equipment provision, discharge lounges, discharge needs of people who are homeless, admission of people with additional needs, guidelines for the acute sector when caring for someone with a learning disability, and common problems and simple solutions. In termediate care, transitional care and sheltered housing are discussed in the next chapter, with an a ction plan and an appendix on housing. The final chapter, on c ontinuing health and social care, asks w hat is continuing care, who is responsible for providing and funding it, where it is provided, and what effect its provision has on delayed transfers of care, ending with sections on assessing the need for continuing health and social care, the d irection on choice for accommodation. dealing with disputes and an action plan. All chapters cite references.

71 references

Subject terms:
hospitals, intermediate care, hospital discharge, short term outcomes, health care, delayed discharge;
Content types:
practice guidance, government publication
United Kingdom
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