Discharge to Assess (D2A) Programme

D2A is part of overall Home First ethos (see foot), which has been described as a ‘Goldilocks approach.’ The key aim is to deliver health and care that’s ‘just right’ as opposed to ‘too much’ or ‘too little’.

Assessing a person in their own familiar environment, as opposed to a clinical/hospital setting, can be less stressful for them. In turn, that enables staff to gather a much more accurate picture of a person’s needs. This is crucially important to ensuring the right package of care is set out, whilst supporting independence.

Yes. Despite well-publicised challenges on the hospital system, patients will only be discharged when it is safe to do so. This means hospital teams consider them as being clinically stable to leave acute care.

Assessments will take place at the earliest opportunity, Community teams will assess and discuss with patients and their families what ongoing support and care will look like and arrange the services accordingly.

The paramount consideration throughout the process is ongoing safety.

There is no ‘one’ operational model that will deliver D2A, and the process works on the basis of simple rules, rather than rigid inflexible criteria.

D2A is, fundamentally, part of the overall Discharge without Delay programme. The DwD programme aims to improve the patient journey, from the initial point of a hospital stay, preventing any delays through early and effective planning. A key aim is to limit hospital stays to what is clinically and functionally essential, getting patients home at the earliest and, crucially, safest opportunity.

This is all based on enhanced communication and collaboration between health and social care staff and partners, ranging from primary care, hospital, community staff and third sector colleagues. The unified aim is to support the best outcome for the person.

No.

Pressures on the hospital system are well publicised and creating and maintaining capacity and flow in our acute system, of course, is a priority. That said, we would not move people home from hospital without it being clinically safe to do so.

In short, whilst discharging someone from hospital frees up a hospital bed, this would not happen unless this condition is in place.

The safest place for a person to recover once you are clinically fit to leave hospital is in their own home or a care home. We want to discharge people as safely and as quickly as possible so they are in familiar surroundings.

For an older person, studies have shown that three weeks in bed reduces fitness equal to 30 years of aging. Deconditioning can exacerbate further delay, as care requirements increase the scope for returning home can diminish. This vicious circle leads to poor patient outcomes and adds even more pressure onto the system – and those who work within it. There is also increased risk for infection during a prolonged hospital stay.

The Home First ethos ensures that people can be cared for at home (or as close to home as possible), prevents avoidable admissions to hospital and, where hospital admission is necessary, supports timely discharge.