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About discharge

Once you are well enough, you will be discharged from hospital – this simply means that the doctors and nurses feel that you no longer need to stay in hospital, and will be able to cope at home.

Many hospital discharges are straight forward and require little or no change to the patient’s lifestyle, home environment and care needs. However, some patients may go through significant changes after an accident or period of illness, and may require additional help once they leave hospital.

Why do we plan discharges early?

Staying in hospital for longer than is necessary can increase your risk of infection and reduce your independence, making your recovery period longer. This is why we need to plan your discharge either before you are admitted or within 24 hours of admission. Our aim is to get you fit enough to go home as soon as possible so that you can recover sooner.

When you are admitted to hospital you will be given an expected date of discharge (EDD) which will be reviewed according to your needs and wellbeing. We will involve you and your family/carer as much as possible when planning your discharge.

Before your discharge we will consider:

  • what your needs are before admission
  • possible changes to your needs following admission, and the level of recovery we expect you to achieve
  • your home environment (for example, stairs within the property, the location of the bedroom and toilet, and so on)
  • any equipment or home adaptation needs
  • social care needs
  • need and eligibility for care packages, continued nursing care and/or other services
  • changes in medications and/or how they are given
  • transport needs
  • any vulnerability, including age, frailty, terminal illness, learning disability and mental health problems.
  • infection control issues.

What are discharge coordinators?

The role of a discharge coordinator is to facilitate the discharge process, particularly when it comes to more complex cases. The role of a discharge coordinator can vary depending on their particular speciality and/or the wards they cover.

It is important to remember that all staff, patients and their families/carers play a part in ensuring a smooth and efficient discharge. If you have any questions or concerns about discharge, please speak to your nurse.

What will happen on the day of discharge?

On the day of discharge you will be asked to have breakfast and be ready to leave the ward soon after. The trust standard is for patients to leave the ward by 11am if possible to help accommodate patients waiting for admission. If you are waiting for blood results, x-ray results or other interventions, your discharge may happen later on in the day. However, it is still important that you are ready to leave in the morning, as you will normally be transferred from the ward to the departure lounge, providing you are well enough.

The discharge lounge is located on level two of the main hospital within Queensway Day Hospital. It is staffed throughout the day with nurses and carers to look after you during the last few hours of your stay in hospital. The discharge lounge also provides a nice environment for you to wait for medications, family, a taxi or (if appropriate) hospital transport. If you wish to find out more about the discharge lounge, please ask a member of staff.

Your medicines

If you will be continuing to take medications that you have brought with you from home, these will be returned to you just before you leave the ward.

If you attended a pre-admission assessment you may also have been asked to purchase some over-the-counter pain relief or other medications in preparation for your discharge.

In some cases you will need new medications to take home. These should be signed off by a doctor and checked by a pharmacist the day before your discharge date. If this does not happen, please speak to your ward team, as the late arrival of your medicines may delay your discharge.

If you need your medications to be organised in a monitored dosage system (blister pack), the pharmacy department usually needs 48hours notice to prepare it. It is therefore important that your needs are discussed with the ward staff well in advance of your discharge date to avoid any delay.

Your medications will be discussed with you, and we will explain how they should be taken, as well as any common side effects that you should watch out for. For more information, you can also refer to the leaflet, You and your medicines, which staff can give you upon request.

You should make an appointment with your GP as soon as possible after leaving hospital to obtain a further supply of any prescribed medications (if needed). Your GP will also update your medical notes and ensure that your medications are reviewed. If you need additional information about your medications, you can contact your local pharmacist for a medicines check-up and review.

Going home

Wherever possible you should organise your own transport to get home. We recommend that you discuss this with the ward staff to ensure family, friends or a taxi collect you at an appropriate time. You will be able to leave the hospital as soon as you have received all the supplies and paperwork required for a safe discharge. We aim to have these prepared the day before your planned discharge date to avoid any delay.

Hospital transport is not available to all patients and the ward staff will only consider arranging this for patients who are eligible. If you require hospital transport, this will be pre-booked for you. However, waiting times can be lengthy, which can be particularly exhausting for patients. For this reason, we encourage families collect their relatives from hospital wherever possible.

What do you need to do to make sure you are ready to go home?

  • If you live on your own, ensure arrangements have been made to turn on the heating (if necessary) and stock up on food and drinks.
  • Finalise any transport arrangements with relatives, friends or carers.
  • If you are in receipt of a care package, alert your care agency 48hours before your planned discharge to ensure adequate cover when you get home.
  • Remove all belongings from your hospital bedside table/cabinet and ensure no valuables are left in the safe.
  • Make sure you have any medications or nutritional drinks belonging to you from the ward fridge.
  • Have suitable clothing for your discharge – this means weather-appropriate and comfortable clothing.
  • Check that you have your house keys or make alternative arrangements.
  • If you have a ‘yellow book’, ensure your coagulation time has been checked and that the book has been returned to you before you leave.
  • If you are going home with anticoagulant therapy, ensure you are given a sharps box for your needles and syringes.
  • If you are on insulin, ensure your dose has been optimised and that your medication prescription has been updated prior to discharge.
  • Ensure you have all the equipment and/or dressings you need.
  • Ensure you receive your discharge letter and any other relevant paperwork.
  • Ask your ward team for any written information leaflets that may help you to manage your recovery at home, and for contact details of any relevant services.

Am I at risk of deep vein thrombosis (DVT) / pulmonary embolism (PE)?

DVT occurs when a blood clot forms in a deep vein, usually in the leg, leading to partial or complete blockage of a vein. If the clot breaks off and travels to the lungs it can block important lung arteries, causing a PE.

Your risk of developing DVT increases:

  • if your leg is immobilised by a cast
  • if you have had surgery or a fracture, particularly to your hip or leg
  • with age (if you are over 60 years old)
  • if you have a medical illness, such as heart or chest disease, cancer or are undergoing cancer treatments
  • in pregnancy or if you have recently given birth
  • if you are immobile
  • with hormone treatment, including the contraceptive pill or hormone replacement therapy (HRT)
  • if you have a personal or family history of DVT or PE
  • with dehydration
  • if you are overweight, with a body mass index (BMI) greater than 30kg/m2.

Common signs of DVT or PE include:

  • hotness
  • pain
  • tenderness and swelling (often in the calf)
  • breathlessness
  • chest pain

You should seek medical advice immediately if you develop symptoms of DVT or PE – early treatment can save lives.

How can I reduce my risk?

You can reduce your risk of developing DVT or PE by:

  • drinking plenty of water and staying well-hydrated
  • being as mobile as possible and exercising your legs
  • maintaining a healthy body weight.

Some patients are advised to continue wearing anti-thrombosis stockings or given treatment until they have returned to their normal level of mobility. If you have been given treatment to continue at home it is important to complete the full course. Remove stockings if they cause discomfort or skin damage and tell your GP.
 

Will I have a follow-up appointment?

Depending on why you were admitted to hospital, you may be offered a follow-up consultation by telephone to ensure that you are managing well at home. Some patients may require home visits from other services for support with interventions such as administering therapies or removing surgical drains/stitches. The hospital will normally arrange this for you prior to discharge.

If you have had an operation or are under a specialist team, you may be given details about how to contact the hospital directly for advice after you have been discharged.

If you are terminally ill or require palliative care, the hospital will ensure that you are fast-tracked to the most appropriate team as required.

Patient reminder checklist

  • Be aware of signs of health deterioration and how to manage them. Ask your nurse before you leave hospital if you are unsure
  • If you are admitted regularly to hospital for the same health issue, please ensure you are referred to a specialist service to help you self-manage your condition
  • Make an appointment with your GP to review your discharge letter and medications list (if needed)
  • Contact your local pharmacist if you need more advice regarding your medications
  • Ensure you have made a note in your calendar of any follow-up appointments or investigations booked for you
  • If you have not heard back from the hospital regarding future appointments, contact the relevant department to ensure this is corrected as soon as possible

Transfer to Community Hospitals

Sometimes patients need further assessment and rehabilitation but do not need to stay in an acute hospital. It may be suggested that you could go to a Community Hospital. We cannot guarantee that a bed will be available in your nearest Community Hospital so you will be transferred to a Community Hospital with a bed available. If a bed later becomes available in a hospital nearer to your home, the doctors caring for you can consider your transfer there.

Please note that unfortunately transfers do sometimes happen at short notice and this is unavoidable.

There is a waiting list for Community Hospitals and it is not unusual for patients to recover in our hospital and go home before a bed is available. If this happens we will support you in your discharge to your own home.

What will happen if I need some help at home when I leave hospital?

There are a number of services that we might be able to use to help you get home.

Physiotherapy

Physiotherapy staff will advise you about managing with moving around and any mobility aids that you may need when you leave hospital.

Occupational therapy

Occupational therapy staff will advise you about coping with everyday tasks when youreturn home. They may also advise you about any equipment you may need on discharge.

Adult Social Services

Adult Social Services staff can, with your agreement, carry out an assessment of your needs to determine whether you are eligible for any support services. They can help and advise on what support may be available to you when you leave the hospital.

If you have a carer who provides support to you they may be entitled to an assessment of their needs. Social Service staff can also provide information about local services and organisations. There is a charge for most services provided by Adult Social Services, but your contribution will depend upon your financial circumstances and the services you require. Adult Social Services staff will be happy to explain this.

Your written consent will be required in order that your details may be given to the Adult Social Services Team for their involvement.

What other services are available to me?

In-reach services

These small teams come from the community health services, but they are based at the hospital. They work alongside discharge coordinators and ward staff to help avoid discharge delays. They are mostly involved with helping services to identify suitable places for rehabilitation.

Home from hospital service

Some patients may only need temporary day-to-day help with activities such as shopping, housekeeping and so on. Age UK offers this kind of help to patients aged 60+ who are living in the Somerset. The service is provided by trained volunteers who can give you practical support and assistance for up to six weeks after returning home from hospital.

For further information, please contact Age UK Somerset on 01823 345 613.

What should I do if…

My district nurse/therapist/other healthcare professional has not turned up. Contact 111 and they will get you in touch with your local community nurses.

My district nurse does not know what equipment I have been discharged with. Ensure you have a relevant contact number for the ward/hospital to pass on to the district nurse for advice.

I need equipment in my home (for example, a commode). Your community services team can help. The NHS 111 advisors will put you in touch with the right community services team.

My discharge letter is missing. Contact the ward and ask them to send you one immediately.

I have been discharged without my medicines. There are a few approaches to this.

  1. If the medication is important, contact the ward immediately to check if it can be sent to you
  2. Take your discharge letter and medications list to a local pharmacy, where you may be issued with an emergency supply
  3. Contact your GP for an emergency prescription

I am diabetic and unsure about my insulin dose. If you have just been discharged, contact the hospital and ask to speak to the discharge coordinator or on-call pharmacist to check your prescribed insulin dose. If you have been at home for a few days, contact your district nurse via the NHS 111 service.

I need a sharps bin for disposal of syringes/needles. Contact your community nurses or specialist nurses (diabetes nurse, for example) via 111. They will be able to arrange this for you and advise you on how to correctly dispose of your needles.

I have needs relating to my medications (a blister pack or medications advice, for example) Please contact your local pharmacy. The pharmacist can give you free medications advice, arrange medications delivery and, if required, provide a blister pack to help you take your medications safely.

 

Additional contacts

If you require further medical help, please contact your GP.

NHS Choices

NHS Choices provides online information and guidance on all aspects of health and healthcare, to help you make decisions about your health.
Website: nhs.uk

NHS 111

You can call 111 when you need medical help fast but it is not a 999 emergency. NHS 111 is available 24 hours a day, 365 days a year. Calls are free from landlines and mobile phones.
Call: 111