Does a discharge to assess programme introduced in England meet the quadruple aim of service improvement?

Researchers from the Applied Research Collaboration Kent, Surrey and Sussex (ARC KSS) have published their findings following an evaluation of a local discharge to assess service. Across the country, discharge to assess pathways were given a significant boost in funding during Covid-19, expanding and extending their reach to further improve the appropriateness of long-term care needs following discharge from acute care. The pathway reduces acute length of stay by moving the point of detailed assessment for ongoing care from the acute hospital into the community with the full assessment 4-6 weeks post discharge. This allows for a period of rehabilitation prior to assessment of long term need within a more suitable environment for the assessment to take place.

Along with local recommendations for the service, the evaluation found evidence that the development of the service had met the fourth aim in the ‘quadruple aim’ of service improvement. Quadruple aim builds on the widely used triple aim (‘improving the experience of healthcare’, ‘reducing the cost of provision’ and ‘improving the wider health of the population’) by adding in ‘improving the work life of staff’. Very few papers have explicitly considered quadruple aim as an outcome framework.

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This initial evaluation has formed the basis for a wider study that is underway across a variety of places in Kent, Surrey and Sussex. This follow on study is focused on the community elements of the pathway and patient experience. It will make recommendations for good practice that are hoped to help inform other systems across the country.

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The Discharge to Assess team are keen to interview people who have been discharged from hospital on a discharge to assess pathway. If you know of anyone who would like to share their experience, please contact This email address is being protected from spambots. You need JavaScript enabled to view it..

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