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Discharge to assess: An evaluation of three case studies in the southeast of England to inform service improvement

Jeffery, Stuart, Monkhouse, Jennifer, Bertini, Lavinia, Walker, Susie, Sharp, Rebecca (2023) Discharge to assess: An evaluation of three case studies in the southeast of England to inform service improvement. BMJ Open Quality, 12 (4). Article Number e002515. E-ISSN 2399-6641. (doi:10.1136/bmjoq-2023-002515) (KAR id:104587)

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Background Discharge to Assess (D2A) emerged as a critical process during the COVID-19 pandemic facilitating patient flow within hospitals, however research on the post-discharge community services of this pathway remains limited. We conducted an evaluation to examine the impacts, capacity, processes and barriers associated with D2A and to identify best practice across three sites in the southeast of England.

Methods We interviewed 29 commissioners, providers and staff members involved in the delivery of D2A pathways within three Health and Care Partnerships. Framework analysis of the collected data revealed three prominent themes: the commissioning of services encompassing funding, structure, culture, and expected outcomes; multidisciplinary collaboration including staff skills, team connections, and coordination; and information and knowledge exchange such as assessment methods, record management, and availability of operational insights.

Results 62 specific enablers and blockers to effective D2A practice emerged.

Discussion These findings supported the development of a comprehensive service improvement toolkit.

Conclusion Five recommendations are proposed: 1. Examination of pathways against the 62 enablers and blockers to identify and resolve pathway obstacles; 2. Establish a local operational policy accessible to all providers; 3. Enhance coordination and communication among service providers, patients and carers; 4. Strengthen oversight of service user flow; 5. Develop a consistent Patient Reported Outcomes Measure to facilitate feedback and service enhancements for individuals discharged from urgent care pathways.

Item Type: Article
DOI/Identification number: 10.1136/bmjoq-2023-002515
Uncontrolled keywords: schemes; early discharge; patients; hospital; community health services; continuity of patient care; organisational theory; patient discharge; quality improvement
Subjects: H Social Sciences
R Medicine
Divisions: Divisions > Division for the Study of Law, Society and Social Justice > School of Social Policy, Sociology and Social Research > Centre for Health Services Studies
Funders: National Health Service (
Depositing User: Stuart Jeffery
Date Deposited: 11 Jan 2024 15:01 UTC
Last Modified: 16 Feb 2024 15:18 UTC
Resource URI: (The current URI for this page, for reference purposes)

University of Kent Author Information

Jeffery, Stuart.

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Monkhouse, Jennifer.

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Walker, Susie.

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