Hospital Discharge

At the end of the day, what we do is we duplicate
a lot of assessments, and that’s not good for the
patient. As you know, we’ve got the CHC side, so
if somebody might be looking as if they might
meet the CHC, then it will go down that route.
They’ll do their assessments, full assessment,
very comprehensive, even a support plan. It isn’t
agreed. It then comes to us. We have then to do
another assessment. … If we’ve got a comprehensive
assessment, why? The integration, to me, should
be that whoever has done that assessment should
be able to then commission and source the care
with a funding stream that is pulled together.
(Social care team, Judy)
A small proportion of participants noted that the
hospital may not be the appropriate place for
assessments, and in particular for patients with
diminishing cognitive abilities (i.e. patients with
dementia or delirium). Instead these participants
suggested that assessments should be carried
out in patients’ homes as they were more likely to
provide a better picture of patients’ needs. Finally,
some participants suggested setting up a liaison
housing officer for patients who were admitted
to hospital with no fixed abode. Participants
reported that these patients overstayed in
hospitals as they did not have a discharge
destination and at times, their discharge was
further delayed because they did not have, and
the hospital could not provide, any new clothes
to wear upon discharge. As a result, a proportion
of these patients experienced delayed and
undignified discharges (i.e. they were discharged
wearing gowns).
7.3
Lens 3 summary
Our findings indicate that a range of factors influence the work of healthcare professionals involved in
(complex) discharge planning. Political and structural (macro), organizational (meso) and individual
(micro) factors affect the discharge planning process. For instance, staff shortages influenced the
level and quality of discharge related care that participants could deliver; similarly, communication
problems among staff and limited knowledge of discharge planning procedures contributed to
delayed discharges. Positive patient experience was often the exception rather than the rule in our
participants’ talk. Organising (complex) discharges does not occur in a vacuum; internal and external
forces influence the type, level and quality of discharge planning that healthcare professionals are
able to provide to their patients and families. Service delivery needs to listen to the stories of health
and social care professionals, understand how they experience delivering discharge-related care
to patients and configure services in a way that meet both patients’ and healthcare professionals’
values, goals, and preferences.
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