The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [48]
Poor discharge planning is considered detrimental to a patient’s physical and psychological well-being (Smith 1996). Patients may return home with insufficient support, resulting in unnecessary readmissions to hospital or struggling at home with inadequate care (Rosswurm and Lanham 1998). Poor discharge planning can result in patients remaining in hospital for longer periods of time than is necessary (Wells et al. 2002). A lack of proactive planning for discharge on or even before admission leads to a longer length of stay (DH 2004a). Therefore it is essential that discharge planning is an ongoing process from preassessment through to the day the patient returns to the community. Given the potential benefits of good discharge planning to patients and their carers and the evidence identifying the impact of poor discharge planning, it is clearly in the best interests of all concerned to ensure that discharge planning is given priority and is seen as a core activity in patient care (Foust 2007, Maramba et al. 2007).
Your Guide to the National Health Service (NHSE 2001) states that from the moment a patient arrives:
Arrangements for discharging you from hospital will begin, and your discharge plan will be agreed with you, taking account of your needs. When you are ready to leave hospital, the nurses and doctors will talk to you about what will happen to you during your recovery and you will be told who to contact in an emergency.
If you need ongoing care at home, your GP, midwife, health visitor, community nurse or Social Services department will be there to help you.
If you need any medical equipment for your return home, the NHS and your Social Services department will aim to provide it promptly. If you need your home to be adapted in any way, your Social Services department will assess your needs.
(NHSE 2001, p.30)
All patients, whether short- or long-stay, those with few or simple needs or those with complex needs, should receive comprehensive discharge planning commenced at the earliest opportunity (DH 2010).
Evidence-based approaches
Principles of discharge planning
The key principles for effective discharge planning are as follows.
Unnecessary admissions are avoided and discharge is facilitated by a whole-system approach to care planning.
Patients and carers should be actively involved in the process (DH 1995, DH 2004b).
Discharge planning should commence on the initial contact with patients.
Complex discharge should be co-ordinated by a named person.
Discharge is a core nursing task (Atwal 2002).
Discharge planning should be a multidisciplinary process by which resources to meet the needs of patients and carers are put in place (Salter 1996).
Effective use is made of transitional, intermediate and enablement care services, so that patients achieve their optimal outcome and acute hospital beds are used appropriately.
Patients and carers understand the discharge planning process and their rights, and receive appropriate information to enable them to make informed decisions about their future care.
(Adapted from DH 2003a)
The discharge planning process and the primary/secondary care interface
The discharge planning process can be initiated by any member of the primary healthcare team (PHCT) or Social Services staff in the patient’s home, prior to admission, in preadmission clinics or on hospital admission (Huber and McClelland 2003). Importance is attached to developing a primary care-led NHS, reinforced by the government’s White Paper The New NHS: Modern, Dependable (DH 1998b). The focus on quality, patient-centred care and services closer to where people live will be dependent on primary, secondary and tertiary professionals working together (Davis 1998).
However, it is important to note that the Community Care (Delayed Discharges) Act (DH 2003b) introduced a system of reimbursement to NHS bodies from Social Services departments for delays caused by the failure of Social Services departments