Discharge to Assess: “Flipping” Discharge Assessment from Hospital to Home

Innovation Case Study

Botwinick L. Discharge to Assess: “Flipping” Discharge Assessment from Hospital to Home. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2017. (Available at www.ihi.org)

Discharge to Assess (D2A) is a redesign of the care process at Sheffield Teaching Hospitals in the UK that involves assessing a patient’s needs after discharge in the patient’s own home rather than in the hospital. Activities that traditionally happen at the end of a hospital admission are instead performed successfully and safely at home, thus enabling patients who are medically ready to go home earlier and spend less time in the acute care setting.

This innovation, also referred to as a “flipped” discharge, started with care of the frail elderly and is currently being spread to other patient populations. The innovation facilitates reduced length of stay and the safe and timely discharge of patients with complex needs, with no increase in readmissions, a decrease in cost, and an increase in patient, family, and employee satisfaction.

Implementation Guide

Pelton L, Knihtila M. Discharge to Assess: “Flipping” Discharge Assessment from Hospital to Home — Implementation Guide. Boston, Massachusetts: Institute for Healthcare Improvement; 2018. (Available at ihi.org)

The accompanying Implementation Guide provides details on implementing the flipped discharge innovation based on the experience of US health care systems participating in the International Innovations Network Learning and Action Community, led by The Commonwealth Fund and IHI.


The Commonwealth Fund, in collaboration IHI, established the International Program for US Health Care System Innovation to identify promising frontline delivery system approaches to health care from abroad that might be transferred to the United States to improve quality of care, control costs, and increase value. This case study presents one of the four selected innovations for which a site visit was conducted, describing the innovation in the local context and discussing considerations for implementing the innovation in the US health care system.

Featured Video
Tom Downes describes how Sheffield Teaching Hospitals used PDSA cycles to help frail elderly patients return home faster.
What If We Flipped the Patient Discharge Process?
At Sheffield Teaching Hospitals in the United Kingdom, an improver came up with the idea of assessing frail elder patients’ needs in patients’ homes instead of at the hospital. One PDSA cycle led to another, and another. Eventually, 10,000 patients got home 3 to 4 days faster in one year.

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