Principle 2: Involve patients and their families in discharge decisions

Patients, their families and their carers often have misconceptions about the benefits of staying in hospital (although as revealed in the Healthwatch Report 2017, a significant number also feel trapped in hospital).

As healthcare professionals, we can occasionally make decisions for a patient based on our belief of what’s in their best interest, without fully involving the patient, their family and carers.

No patient should feel that they are being prematurely discharged from hospital. But nor should they be kept in hospital unnecessarily. So, it’s vital that patients:

  • Understand the psychological and physical benefits of being out of hospital
  • Are equipped to make an informed decision

In order to do so, patients and families need to understand the harm to function of being in hospital when there is no acute medical need that can only be dealt with in a hospital environment. Teams should be able to have high quality conversations to explain this.

We should ask patients what matters to them, gather information from paramedics, carers and family and ensure that this information stays with them throughout their hospital journey.

Ultimately, everyone involved (especially the patient and their family) should be able to answer four key questions:

  1. What is the matter with the patient (or what are we trying to exclude)?
  2. What have we agreed we are going to do to help the patient’s recovery – now, later today and tomorrow?
  3. What needs to be achieved to get the patient out of hospital (i.e. what are the CCD)?
  4. If recovery is ideal and there is no unnecessary waiting, when should the patient expect to go home?

Using these four questions helps ensure that each patient’s plan is personalised and tailored to their individual needs, and that they and their families (and carers) can drive their own care and ask informed questions.

Use conversations with the patient and their family or carer to ensure that arrangements are made for patients to be able to get into their home and have heating and food available.

It’s recommended that all sites have a training approach in place to help staff have open discussions with patients, their families and carers about the options available and the potential outcomes. The Gold Standards Framework can provide useful training on this issue.

Getting patients up, dressed and moving during hospital stays has been shown to reduce falls, improve patient experience and reduce length of stay by up to 1.5 days. Find resources and more data on this subject at the PJ Paralysis website.

Links to further resources