Discharge to Assess (D2A) supports the discharge of people from hospital who are clinically stable but who require further assessment to establish their on-going health and social care needs.
NHS England describe D2A as: “Where people who are clinically optimised and do not require an acute hospital bed, but may still require care services are provided with short term, funded support to be discharged to their own home (where appropriate) or another community setting. Assessment for longer-term care and support needs is then undertaken in the most appropriate setting and at the right time for the person.”
What are the three pathways?
There are three pathways (one, two and three) within the D2A process.
Pathway one: assessment and support is provided by the health and social care community team in the patient’s own home. The expected maximum assessment period is 14 days.
Pathway two: assessment and support is provided by the health and social care community team in a residential assessment setting. This includes community support beds in Derbyshire county and pathway two beds in Derby city. The expected maximum assessment period is 14 days.
Pathway three: assessment and support is provided by the health and social care community team for people who initially require 24-hour nursing care. The expected maximum assessment period is 20 days.
A person may be stepped up or stepped down between the pathways as appropriate to their needs.
The support provided may involve rehabilitation (a therapy/nursing-led service) and/or re-ablement (a social care-led service).
How does the process work?
1. On the hospital ward a referral is made to the Integrated Discharge Team
2. The Integrated Discharge Team review the referral. They identify the appropriate pathway, liaise with the relevant staff, and arrange the discharge from hospital.
3. The community team assess the person’s on-going care needs and discharge to identified services if required.
Who is appropriate for D2A?
People who can be considered for the Discharge to Assess process are:
- Derbyshire residents requiring support on leaving hospital, from either hospitals in or outside Derbyshire
- People aged over 18 years who require an assessment to determine their on-going health and/or social care needs
The D2A process is not necessary for all hospital discharges. People who are returning to their usual residence, to existing services, and have no additional needs which need to be assessed, will be subject to the routine discharge processes. There may be other exceptions where someone’s long-term care needs may be assessed in an acute hospital.