Going home from hospital: the carer/patient dyad

Aims. This study aimed to provide an in-depth understanding of the process of hospital discharge experienced by the carers of patients 'at risk' of un successful discharge from medical wards in three hospitals in the North of England. Background. The Community Care Act and the Carers Recognition and Services Act placed responsibility on service providers to ensure the smooth dischar ge of patients from hospital making sure that appropriate community service s are in place to support the patient and their informal carer following di scharge from hospital. The study, from which this paper is taken, identifie d patients at risk of unsuccessful discharge and tracked the experiences of the patient and their carer through the discharge process. For the purpose of the study unsuccessful discharge is defined as unplanned readmission wi thin 6 weeks of discharge or extended length of stay. Design. The study combined qualitative and quantitative methods to identify factors leading to unsuccessful discharge. Logistic regression was used re trospectively with the records of 1500 patients to identify factors predict ing unsuccessful discharge. A sample of medical patients predicted to be at risk of unsuccessful discharge, their formal and informal carers, were fol lowed through the discharge process using qualitative techniques to look at decision-making and outcomes related to discharge. Findings. This paper presents findings relating to patient/carer experience s of the discharge process. It explores the obligate moral climate in which the role of carer is negotiated between professionals, patients, family me mbers, friends and neighbours and the differing assumptions about duty asso ciated with caring roles in hospital and in family and community settings. Conclusion. The discussion adopts a critical theory perspective to examine the contradictions confronting practitioners, patients and carers arising f rom hospital policies which promote cost-effective and efficient use of exp ensive technical resources while simultaneously seeking to identify and mee t the needs of patients and carers for care.