Planned Date of Discharge

This is not a new idea. The change is based, however, on an improved system of working, with smoother, more seamless links between NHS staff, the hospital-based social care workers and the community team.

Prior to PDD patients were, broadly speaking, referred for social care supports when they were clinically ready to leave hospital. This meant patients could be delayed in hospital while assessments and arrangements for care at home or in a community setting were finalised.

PDD ensures the risk of a patient’s discharge being delayed is significantly reduced. This is due to the assessment and planning-for-discharge process beginning at the earliest possible stage – and not waiting until the patient is clinically ready.

• A multidisciplinary team which includes input from medics, nursing, discharge coordinators, and social work sets the PDD, working and communicating with the patient, family and carer. Discharge planning (PDD) should happen daily as part of the MDT along with other aspects of care reviews.
• As well as clinical considerations, this involves the team gathering information from the patient and their family and/or carer. This dialogue should support the team to decide what the best plan will be for the patient as an individual. 
• Based on all of these considerations, the team should then provide the PDD, establishing a specific date so the patient, their family or carer are fully aware.
• The PDD should be recorded in the patient’s notes and shared with family/ carers and should also be recorded on trakcare.
• The patient should be discharged with their discharge care plan and details of any community supports that have received referrals, eg district nursing, physiotherapy, GP.

Taking the aforementioned process/dialogue into account, the PDD should be set as soon as feasible following admission.  Similarly, referrals for social care/social work intervention, (e.g. equipment, and care at home package or community care assessment) should also happen at this early stage, wherever practicable.

With this early planning in place, referrals for social work intervention can be received in sufficient time to avoid any delay when the patient in clinically fit to leave hospital.

Please note, for any equipment, aids or adaptations required, orders should also be made at this early stage as it can take 2-3 days for equipment to be put in place.

As part of the patient’s recovery, a patient may be moved to an alternative facility where they will receive more specialist rehabilitation or care to help them fully recover. 

Please note, the PDD should be set by the initial receiving ward. This date should move with the patient.  The PDD only changes if the clinical presentation changes.

Yes. We have created an animation and a patient leaflet. This explains the PDD process and is available for staff to share with patients and their families. Please share this with families.

We encourage staff to record the PDD and display this by patient’s bed and to  share with family/carer. If appropriate, the PDD should be shared with the care home the patient will be returning/being admitted to following discharge from hospital.

Our overriding priority is patient safety. The PDD can be changed if the patient isn’t well enough to be discharged. This should be agreed with the MDT.

Any move to a PDD date should be logged with the discharge coordinators. This will be recorded as a PDD +1 etc. This will done with the agreement of the multidisciplinary team.

Clearly, changing the PDD will have implications for any social work provision/partner arrangements that had been organised in anticipation of the patient’s original discharge date. If a patient’s PDD is changed this should be communicated to social work colleagues – or any partner involved in the patient’s discharge – with urgency/at the earliest opportunity. This is to allow care packages to be kept open/alternative arrangements to be put in place. 

Covid-recovered residents should always be isolated for a minimum of 14 days from symptom onset (or first positive test if symptoms onset undetermined).  They do not require to spend all 14 days in hospital but should have 2 negative tests before discharge from hospital (testing can be commenced on day 8). Tests should be taken at least 24 hours apart and preferably within 48 hours of discharge.

Where testing is not possible (e.g. resident doesn’t consent or it would cause distress) a risk assessment and an agreed care plan for the remaining period of isolation up to 14 days in the home must be agreed.

Non-Covid residents being discharged from hospital should be isolated for 14 days from or including the date of discharge from hospital.  Testing should be done preferably within 48 hours prior to discharge from hospital. Risk assessment prior to hospital discharge should be undertaken in conjunction with the care home.

A single negative result should be available before discharge. The exception is where a resident is considered to suffer detrimental clinical consequence or distress if they were not able to be discharged to a care home. In these cases, the resident may be discharged to the care home prior to the test result being available. Whether the result is positive or negative, 14 days of isolation must be completed.

A dedicated email address has been set up for staff involved with PDD. Please send any enquiry to pddcomms@lanarkshire.scot.nhs.uk and we will endeavour to answer questions as quickly as possible.

The patient/ carer and family should be given a copy of the discharge information/ medication together with information on any care package/ care facility.

Any onward referrals to other services such as physiotherapy, nursing etc should be explained to the patient.

If there are original documents which belong to the patient eg Power of Attorney, Anticipatory Care Plans, Do Not Resuscitate Documentation or Adults with Incapacity Documentation they should also be returned.