NHS England has set out a model discharge pathway, noting seven principles of discharge and what organisations need to have in place to deliver the model. “While the components of good discharge are well understood, they are not applied consistently,” NHSE notes. “There is still unwarranted variation between wards, sites and systems, and across different days and times of year.”
The model puts focus on early decisions about those who can be supported through alternative pathways such as virtual wards (Hospital at Home). Local teams will increasingly play a critical role in supporting those with complex needs as neighbourhood-based care develops, NHSE explains, with plans for proactive in-reach into wards and collaboration with hospital teams on early discharge.
The seven principles of discharge include that discharge should be a clinical, not an administrative decision; longer-than-necessary hospital stays cause harm; timely discharge is essential for patient flow and safety across urgent and emergency pathways; discharge home as default; discharge as “everyone’s business”; patients and carers as partners in discharge; and decisions informed by high quality data.
From acute settings, intended discharge pathways including virtual wards should be identified early, “remain visible” to the ward team, and be discussed early with patients and any family or carers, NHSE states. Daily consultant-led board and ward rounds should review progress toward discharge, adapt plans if necessary, and identify actions needed to progress care, with teams considering whether any remaining activities normally carried out in a hospital could be carried out in another setting such as a virtual ward or as an outpatient.
Preparations should be made to avoid delays on the day of discharge, with NHSE suggesting that the use of digital solutions including AI and automation may support timely preparation of discharge documentation and help reduce the admin burden on frontline teams. Having clear nationally defined criteria to reside, translated into local ward-friendly language and patient-specific discharge criteria means out-of-hours and weekend medical staff like on-call consultants and resident doctors can make prompt and safe discharge decisions, reducing avoidable weekend stays, it continues.
Eligibility and referral routes to virtual wards, intermediate care, and community services should be simple, clear, and used early, with capacity across services visible to discharge teams, NHSE shares. In-hospital assessments should focus on identifying the discharge pathway, immediate support for safe discharge, and next steps. Case management tools may be used to support real-time tracking and coordination across organisations. Hospitals should have a single view of core discharge information, including expected dates and discharge pathways, consistently recorded in EPRs.
NHSE also covers the need for a single point of coordination such as a care transfer hub to work across acute, community, and social care partners to progress complex discharges; and a named clinician responsible for timely discharge for each patient and overseeing coordination.
To deliver the model, each hospital setting should compare their current operating model and practices against its core elements, NHSE recommends, identifying gaps and developing plans for improvement. Each system partner should identify a named executive director with overall accountability for discharge performance, supported by operational and clinical leadership for discharge at division, specialty, and ward level.
A review of data requirements will be undertaken to form a coherent set of operational tools to support hospital and system flow, NHSE goes on, but in the meantime, trusts should use two metrics: number of discharges required and delivered each day by pathway, and number of patients no longer requiring care in a hospital who can be better supported at home or in the community. These two metrics will also reportedly be tracked nationally.
Wider trend: Virtual care
“Positive early results” are reportedly being seen from a virtual ward pilot for older adults with complex mental health needs in Sussex, with services being delivered via a combination of remote and community-based care. The pilot is part of a wider transformation programme across the region, offering support to older people to remain in their own home or care home rather than being admitted to hospital, mitigating distress and confusion that can accompany admissions, as well as discharge delays waiting for support for ongoing care needs.
West Hertfordshire Teaching Hospitals has shared key findings from an in-depth evaluation of its Hospital at Home (HAH) service, including an 80 percent reduction in costs compared with hospital care, improved outcomes, and high rates of patient satisfaction. The evaluation, published in Frontiers in Digital Health, analysed patients admitted to the HAH service between April 2023 and April 2024, across pathways including heart function, airway disease, and acute respiratory infection. Outcomes measured looked at length of stay, total bed-day costs, 30-day readmission rates, 90-day mortality, and patient experience.
South East Coast Ambulance Service NHS Foundation Trust has set out its target operating model for virtual care, looking to build on existing success and introduce a unified digital approach to support “more predictable” waits, improved risk identification, and smoother patient flow. According to the trust, the new model will offer more consistency in clinical assessment for patients, expanded alternatives to ED conveyance, improved partnership working through more accurate referrals and shared records, and standardisation across tools, digital integration, and clinical escalation or advice points to support staff.
