27 Analysing the causes of these delays, Tierney et al. The problems of delayed or poorly planned discharge illustrate the broader challenge of integrating health and social care. For example, the 28-day readmission rate for older people has doubled from 103,000 in 2001–2 to 201,000 in 2010–11, 50, 51 suggesting that more needs to be done to support patient recovery following acute care. In parallel, premature discharge or discharge without appropriate arrangements for onward care can also lead to complications for patient recovery.

27, 48 According to Victor et al., 49 nearly 30% of older people experience some delay in their hospital discharge, which is known to expose patients to additional hospital-related risks, create emotional and physical dependency, incur additional hospital costs and restrict the availability of inpatient beds. The inherent complexity of co-ordinating a large number of actors, often based in distinct organisations, leads to the view that hospital discharge can be a vulnerable, time-dependent and high-risk episode in the patient pathway.Ī prominent example of this complexity is ‘delayed discharge’, where the patient remains in hospital because of the failure to appropriately co-ordinate care between agencies. 14, 48 The organisation and provision of this transitional care typically involves multiple health and social care actors, who need to co-ordinate their specialist activities so that patients receive integrated and, importantly, safe care. Reflecting this, hospital discharge is not an end point, but rather one of multiple transitions within the patient’s care journey. Hospital discharge describes the point at which inpatient hospital care ends, with ongoing care transferred to other primary, community or domestic environments.

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