Hospital Discharge Pathways and Planning
Hospital discharge pathways are designed to ensure that patients receive the right level of care after leaving the hospital. In England, the Discharge to Assess (D2A) model is commonly used, allowing patients to leave the hospital as soon as they are medically stable and continue their assessment in a more appropriate setting. The main discharge pathways include:
- Pathway 0: The patient is well enough to return home with no additional support.
- Pathway 1: The patient can return home but requires short-term care or reablement services.
- Pathway 2: The patient needs a period of rehabilitation or recovery in a community hospital, intermediate care bed, or care home.
- Pathway 3: The patient has complex needs and requires long-term care in a residential or nursing home.
Each discharge should be carefully planned to avoid readmission and ensure the patient’s safety and wellbeing at home or in a care setting.
Bed Pressures and Discharge Processes
Hospitals face significant bed pressures, particularly during winter months and periods of increased demand. Delays in discharge can create bottlenecks, preventing new admissions and increasing pressure on emergency departments. To manage this, hospitals prioritise early discharge planning, often starting from the point of admission. Efficient discharge relies on a coordinated effort between medical teams, social care, and community services. Key steps in the process include:
- Medical and Therapy assessment to confirm the patient is medically and therapy fit
- Care needs assessment, often conducted by hospital social workers or ward staff
- Identifying funding options, such as NHS Continuing Healthcare (CHC) or social care funding.
- Organising care services, equipment, or adaptations if needed at home.
Key People to Speak to When Discharge Planning
When planning a discharge, speaking to the right professionals ensures a smooth transition:
- Ward nurses and doctors – They confirm medical stability and provide discharge summaries.
- Discharge coordinators – They manage the logistics of discharge and liaise with community services.
- Social workers – They assess ongoing care needs and coordinate social care support if required.
- Occupational therapists and physiotherapists – They assess mobility, rehabilitation needs, and any necessary home adaptations.
- Community nursing teams – They arrange district nurse visits for wound care, medication, or ongoing health support at home.
- Care providers – If home care or a care home placement is needed, care agencies or homes must be identified and engaged.
Proactive discharge planning reduces hospital delays and ensures patients receive appropriate and timely support, reducing the risk of readmission or crisis care needs.
