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By Root 1996 0

Report (Garrett and Boyd 2008), an independent patient survey, identified that 16% of patients questioned reported that they did not feel involved in their discharge. The hospital discharge process is also a critical time for informal carers (Higginson and Costantini 2008) yet Holzhausen (2001) suggests they do not feel involved in the discharge process. It may be the first time they are confronted with the reality of their role, the effect it may have on their relationship with the person needing care, their family and their employment (Hill and Macgregor 2001). Research suggests that if carers are unsupported, this can result in early readmission of the patient (Holzhausen 2001).

The Carers Act 1995 was implemented to support carers in a practical way by providing information, helping carers to remain at work and to care for themselves. Under the Act, carers are entitled to their own assessment and many support services can be provided, including respite, at no charge.

Throughout discharge planning, carers’ needs should be acknowledged. Carers may have different needs from patients and there may be conflicting opinions about how the patient’s care needs can be met. It is not uncommon for patients to report that their informal carer is willing to provide all care but the carer is not in agreement with this. Healthcare professionals should allow carers sufficient time, provide appropriate information to enable them to make decisions, provide written information on the discharge plan and ensure adequate support is in place before discharge (Hill and Macgregor 2001). This will promote a successful and seamless transfer from hospital to home.

Communication and discharge planning

Effective, safe discharge planning needs to be patient and carer focused. Therefore it is dependent on a multidisciplinary approach and the sharing of good practice (Ashby and Mendelson 2009, Martin 2001). There is consistent evidence to suggest that best practice in hospital discharge involves multidisciplinary teamwork throughout the process (Borill et al. 2001). The multidisciplinary approach, where all staff have a clear understanding of their roles and responsibilities, will also help to prevent inappropriate readmissions and delayed discharges (Stewart 2000). This approach also promotes the highest possible level of independence for the patient, their partner and family by encouraging appropriate self-care activities.

Ineffective discharge planning has been shown to have detrimental effects on a patient’s psychological and physical well-being and their illness experience (Cook 2001, Kissane 2004). Planning care, providing adequate information and involving patients, families and healthcare professionals will keep disruption to a minimum. Poor discharge planning can also result in patients remaining in hospital for longer than is necessary (Wells et al. 2002).

To achieve the best quality of life for patients and carers, there needs to be good co-ordination in terms of care planning and delivery of that care over time (Speck 1992). Discharge co-ordinators are generally health or social care professionals who have both hospital and community experience. Their role is to advise on and help with planning the care patients may need when leaving hospital, particularly when the nursing and care needs are complex. McKenna et al. (2000) cite poor communication between hospital and community. Discharge processes (DH 2004a) endorse the value of co-ordination in a climate of shorter hospital stays and timely patient discharge.

For complex discharges, it is helpful if a key worker, for example the discharge co-ordinator, is appointed to manage the discharge and, where appropriate, for family meetings/case conferences to take place and include the patient/carer, multidisciplinary team and PHCT and representatives (Health Services Accreditation 1996, Salter 1996). Additionally, a guide to planning a complex discharge (Box 2.14) can highlight the communication required by the multidisciplinary team.

Box 2.14 Guide to arranging a complex discharge home