Hospital discharge: arranging the nursing handover at home
Written by Rabah Slimani, State-registered nurse · · 3 min read
Reviewed on · Reviewed by Julie Martin
What the practice asks for, what it guarantees and within what deadlines, so a hospital discharge becomes home care with no gap: the call, the documents, the first visit, the supplies, the written report.
Key points
- A discharge is prepared in advance, not on the day: 48 hours is almost always enough, a few hours rarely is.
- Four things decide whether a handover is accepted: prescription, protocol, available supplies and an address inside the sector.
- The practice confirms feasibility the same day the request arrives, including when the answer is no — a fast refusal beats an uncertain yes.
- A written report goes to the ward and the GP after the first visit, without waiting for an incident.
Why a discharge fails, when it fails
A handover that breaks almost never breaks on clinical technique. It breaks on an administrative detail: an unsigned prescription, supplies ordered but not delivered, an address outside the sector discovered at the door, a phone number that stops answering at 5pm on a Friday.
The cost of those details lands on the patient: a day without a dressing, a delayed infusion, an avoidable return to A&E. That is why the practice treats discharge planning as care in its own right, with the same traceability requirements.
This piece therefore describes a procedure, not an intention. Every step has an owner, a deadline and written evidence.
Hospital discharge: who does what, on which side
A break in care almost never comes from a missed procedure, but from a box nobody ticked between two organisations.
The hospital ward
Discharge prescription
The ward writes down the care to continue and the date of the first expected visit.
Equipment
The ward states what it supplies and what must be ordered from a pharmacy.
Discharge report
The ward sends its report to the family doctor, who remains in charge of follow-up.
The home-care practice
First contact
We confirm that the sector, the rhythm and the equipment are covered before discharge.
First visit
We come on the agreed date, with the prescription and the discharge report at hand.
Field feedback
We write down what we observe at home and send it to the family doctor.
The sequence, from first call to first visit
Five steps, none of which requires a shared software platform: a phone, a secure health messaging address and a legible prescription are enough.
The feasibility call
The ward, the social worker or the PRADO scheme calls with four facts: town, planned discharge date, type of care, expected frequency. A feasibility answer is given the same day.
Sending the documents
Discharge prescription, discharge summary, specific protocols and the GP's contact details arrive through secure health messaging — never a personal mailbox, never an unreadable photograph.
Checking the supplies
The practice checks that everything needed is prescribed and available at the pharmacy before discharge: dressings, infusion sets, sharps container, and a hospital bed where required.
The first visit
It is booked on a named slot, not a vague half-day. It lasts longer than later visits: home assessment, setting up the protocol, explanation to the patient and relatives.
The written report
Within 24 hours of the first visit, a report goes to the referring ward and the GP: what was done, what is missing, what worries us.
Stated deadlines, and what they assume
These are the practice's own deadlines, not a sector average. They assume a complete request: an incomplete one is put on hold and the sender is called back.
| Request | Response time | Condition |
|---|---|---|
| Feasibility of a handover | Same day, on weekdays | Town, discharge date and type of care stated. |
| First visit scheduled | Within 48 working hours | Prescription received and supplies available at the pharmacy. |
| Same-day discharge | Assessed case by case | Accepted if the day's round allows it, clearly refused otherwise. |
| First-visit report | Within 24 hours | Ward's secure messaging address provided. |
What the practice asks the ward for
This list fits on half a page and removes nearly every round of phone tag.
- The signed, dated discharge prescription, with frequency and duration of care
- The discharge summary or, failing that, a one-page clinical synthesis
- The exact protocol for technical care: wound, infusion, implanted port
- The name and number of someone reachable on the ward for 72 hours
- The patient's agreement and the exact address, floor and door code included
What the practice does not take on
Saying no quickly is a service. The practice declines a discharge when it falls outside the sector, when the protocol belongs to hospital-at-home or a technical platform, or when continuity cannot be guaranteed for the prescribed duration.
In that case the answer does not stop at the refusal: where we know of one, we point to another provider in the same area.
A reasoned, immediate refusal protects the patient better than an agreement in principle that collapses the night before discharge.
Working alongside hospital-at-home, SSIAD and suppliers
Hospital-at-home is delivered by an authorised structure: the practice then works alongside it, never in its place, and follows the protocol that structure defines.
A home nursing service covers long-term hygiene and monitoring for dependent people; prescribed technical procedures remain ours to deliver alongside it, with no double billing.
With equipment suppliers the rule matches the pharmacy one: we flag needs before discharge and check delivery, but we do not stand in for a supplier whose device requires their own installation.
The forty-eight hours that decide the handover
When a discharge fails, it almost always fails in the two days around it. This is the sequence we keep with wards.
D-2: the date is announced
The ward or social worker sends us the planned date, the procedure required and its frequency.
D-1: feasibility check
Area, scope, supplies, room in the round. Answer given the same day, including when it is a refusal.
D-1: supplies and treatments
Provider alerted, pharmacy informed, prescription available at the home.
Day D: first visit
Set-up, review of the discharge file, liaison sheet put in place.
D+1: first handover note
To the GP: observed condition, discrepancies with the report, points to decide.
The gaps we see most often
Three gaps recur: a discharge prescription incomplete for devices, a treatment changed in hospital without the home being told, and equipment delivered after the return rather than before.
None of these is an individual failing: they are chain effects. Naming them is how they get anticipated — which is exactly what the day-before feasibility check does.
When to call
An earlier discharge, a cancelled discharge, a change of return address, a treatment changed on departure day, missing equipment, a patient home without a prescription: call, even late, rather than sending writing that will be read tomorrow.
A three-minute call the day before prevents a night without care.
What we ask the ward for, in one page
The discharge report, a complete prescription including devices, an up-to-date treatment list, contact details for the referring ward, and the real discharge date — not the one considered at the start of the week.
One page is enough. What we need is not the whole hospital file: it is what allows the care to be delivered correctly from the first visit, and tells us whom to call if something does not match.
The first week, watched closely
The first seven days concentrate most avoidable readmissions: treatment badly resumed, pain poorly controlled, a wound turning complicated, isolation for someone who was surrounded in hospital.
So we deliberately tighten the visits early on, even if they are spaced out later. This is not extra billing decided alone: it is a rhythm proposed to the prescriber and approved by them.
Frequently asked questions on this page
How far in advance should the practice be told about a discharge?
Does the practice accept a discharge announced on the day?
How should discharge documents be sent?
Does the ward get feedback after the first visit?
Can the practice decline a discharge?
Who liaises with the equipment provider?
Terms explained
- PRADO
- The health insurance discharge support programme: an adviser arranges the first community appointments from the hospital before discharge.
- Home hospitalisation (HAD)
- A structure delivering hospital-level care at the patient's home, with its own medical coordination.
- SSIAD
- A home nursing service providing prescribed care and personal hygiene support for older or disabled people.
- Handover notes
- The written record of a visit: what was done, what was observed, what must be watched. The shared memory of the care episode.
- Prescription
- A doctor's written order stating the procedure, frequency and duration. Without it, nursing care cannot be delivered or reimbursed, apart from procedures allowed in direct access.
- MSSanté
- The French secure health messaging system, used to exchange health data between professionals, and with patients, outside ordinary email.
Official sources
What we write is based on public references you can check for yourself.
This page is informational and replaces neither a medical consultation nor a prescription.