Practice Competent Novice

Planning a patient’s discharge from hospital

BMJ 2008; 337 doi: http://dx.doi.org/10.1136/bmj.a2694 (Published 12 December 2008) Cite this as: BMJ 2008;337:a2694
  1. Srinivasa Vittal Katikireddi, specialty registrar in public health medicine 1,
  2. Geoffrey Christopher Cloud, consultant physician in geriatric and stroke medicine2
  1. 1NHS Lothian, Edinburgh EH8 9RS
  2. 2Department of Clinical Neuroscience, St George’s Hospital, London SW17 0QT
  1. Correspondence to: S V Katikireddi vkatikireddi{at}yahoo.co.uk

    Junior doctors have an important role to play in planning a patient’s discharge form hospital

    Summary points

    • Discharge planning aims to improve the coordination of services and care after a patient’s discharge from hospital

    • Good planning requires anticipation of potential problems by good information gathering, early resolution of potential barriers to discharge, and timely referral to the multidisciplinary team

    • Planning involves close collaboration between the patient, the family, and the multidisciplinary team; this leads to improved patient and carer satisfaction

    • The junior doctor is often an important coordinating link in the process of discharge

    Discharge planning is a process that aims to improve the coordination of services after discharge from hospital by considering the patient’s needs in the community. It seeks to bridge the gap between hospital and the place to which the patient is discharged, reduce length of stay in hospital, and minimise unplanned readmission to hospital.1

    Discharge planning is an established part of hospital care, but the process varies and is not entirely evidenced based. A Cochrane review analysed 11 randomised controlled trials looking at discharge planning in over 5000 patients and failed to show a reduction in mortality among elderly medical patients, lower readmission rates, or a shorter length of hospital stay.1 However, two trials in the review did report greater satisfaction of patients and carers when discharge planning was used.2 3 The Cochrane review concluded that discharge planning remains important as a small improvement, not detected by the studies performed so far, could still yield highly significant gains in health care with huge resource implications and better use of acute hospital beds.1 Unfortunately, none of the included trials assessed communication with primary care staff about patient transfer of care. This is an important aspect of discharge planning and another potentially important advantage for patients. …

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