In this joint blog, Sarah one of our callers and Debs, the helpline advisor who took her call, explore what safe discharge from hospital looks like, and what might help should anyone find themselves in an unsafe situation.

What a safe discharge process might look like

The transition out of hospital back home or to stay with a loved one can feel different, depending on the patient and their personal situation. For many patients, it can feel disorientating and cause some anxiety. The NHS has a set of guiding principles on about what should happen:

• There is a duty for NHS bodies and local authorities to co-operate with each other and agree the best discharge model.
• That any decision should involve families and carers
• And that Care Transfer Hubs are seen as good practice.

Depending on what a patient might require during their next stage of recovery, they’ll be assigned to one of four different discharge pathways

1. pathway 0: to home or to a usual place of residence with no new or additional health and/or social care needs
2. pathway 1: to home or to a usual place of residence with new or additional health and/or social care needs
3. pathway 2: to a community bed-based setting which has dedicated recovery support. New or additional health and/or social care and support is required in the short-term
4. pathway 3: to a new residential or nursing home setting, for people who are considered likely to need long-term residential or nursing home care.

---

Sarah’s story

Tragically, in this case, Sarah believes her son’s discharge from hospital was verging on negligent. She wanted to share her story, not to blame anyone but to share her thoughts on what would have made a difference to her son, and to offer her thoughts on what may help others if faced with a similar situation after discharge.

"My son had been in hospital for nearly two months with complex  complications from a double lung transplant the previous year. When he was discharged from a leading Teaching hospital, he ended up after five days at home, collapsing in another hospital where he was admitted to ICU and put on a ventilator again. Tragically after a further two months in  two different hospitals, he passed away." 

Based on their experience, Sarah shared with us a list of things that would have helped her and her son in this situation:

• A pre-discharge chat between hospital staff and the patient/carer to discuss anything that might be helpful to have at home before discharge.
• A GP visit for the next working day, to make sure everything is on track.
• Written and verbal information for patients and their families about what to do if something goes wrong after discharge. This should include guidance on when to seek help if the patient's condition worsens or new symptoms develop. Information should be provided in accessible formats (such as easy read) and available in the patient's first language, giving families a clear reference point if they feel confused or stressed after leaving hospital.
• Basic health equipment such as a thermometer, pulse oximeter, or blood pressure monitor available to help keep an eye on recovery.
• Organising medications in a clear plastic box, listing them clearly (alphabetically can help), and keeping the instructions simple makes them much easier to manage.
• Helpful equipment around the home like a commode, perching stool, walking aid, or raised toilet seat can make daily life safer. Urine pots can usually be requested from the GP, but some items (such as incontinence pads) may need to be bought until a referral is made.
• If stairs are difficult, consider setting up a bed downstairs for a few weeks. A commode nearby can also help reduce the need for climbing stairs.
• Stock up on nourishing meals and consider nutritional supplement drinks if the patient needs to regain weight or strength.
• Ask about simple physiotherapy exercises or look up safe routines to help rebuild strength. Even knowing how much walking to try each day can make a difference.
• Make sure anyone helping to look after the patient knows they can call 111 or 999 in an emergency if they’re worried, and keep any discharge paperwork close by to share important information quickly.

There are many resources on the internet about discharge and what to do, but we hope this blog can alleviate some of the anxieties around having a loved one home after a hospital visit. We believe that equal partnership with patients improves safety and the quality of services, and it should go without saying that communication is key. Sadly, as Sarah knows too well, not communicating well can have dire consequences. 

---

Patients can talk directly to our helpline team, in confidence, about any concerns, questions or general experiences they have regarding the NHS and care systems. 

If you would like to contact the helpline, please call free on 0800 345 7115, or or email [email protected]. If calling from outside of the UK please dial +44 208 4238999. The helpline is open from 9.30am to 5pm, Monday to Friday, and calls outside these times are returned as soon as possible during opening hours.