The East Lothian discharge to assess service

A three-year project to embed discharge to assess (D2A) as a core East Lothian service

The East Lothian discharge to assess service

Jo Pilarksa, advanced physiotherapy practitioner, shares her highlights of a three-year project to embed discharge to assess (D2A) as a core East Lothian service

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  • To promote a change in culture from the ‘assess to discharge’ model of care

    As of April 2020:£1,048,500 estimated cost saving (cost calculated at £300 a day)

  • To facilitate timely and effective discharge of patients who are clinically fit and appropriate to have their therapy assessment at home
  • To develop a culture of ownership of East Lothian patients throughout their patient journey


D2A referral criteria and pathway was established in 2015 in consultation with NHS Lothian acute sites and East Lothian Council. D2A enables: 

  • Comprehensive same day or next day physiotherapy/occupational therapy assessment 
  • Ongoing person-centred care delivered in a patient’s own environment, including provision of equipment, minor adaptations and short term therapy support
  • Education and awareness sessions delivered to referring staff
  • Standardised recording and audit processes
  • Collaborative working with East Lothian discharge co-ordinators and community teams  
  • Daily screening of admissions lists from acute hospitals to proactively ‘pull’ patients from hospital
  • Weekly in-reach by the D2A team to orthopaedics, stoke and medicine of the elderly at the Edinburgh Royal Infirmary.


  • D2A is now fully embedded within the wider East Lothian community services and is a key alternative discharge pathway
  • D2A fulfils NHS Scotland’s strategic aims, of returning patient to their own homes as soon as appropriate, with minimal risk of re-admission.

Next steps

  • Development of a seven day working initiative to support weekend discharges
  • Extend site coverage and capacity of D2A in-reach
  • Creation of a locality based health and council rehabilitation team supporting discharges and prevention of admissions. 

Top three learning points

  1. Developing a culture of ‘ownership’ of our East Lothian patients has enabled us to support patient flow and effect positive change on discharges.
  2. Enhancing communication links between clinicians and services across community and acute sites has been crucial in building relationships and trust.
  3. Developing a shared vision was a key part of our success. 

Author’s reflections

Following the initial D2A project phase, we went on to complete a one-year test of change named START (Short Term Assessment and Rehab Team) which brought together health and social care staff across East Lothian into one team. This team worked closely with primary care to enhance our D2A supported discharge pathway, providing high intensity, high frequency rehabilitation at home and in turn reduced duplication between services and improved patient experience. 

This project has also given rise to a new physiotherapy and occupational therapy-led, prevention of admission referral pathway in East Lothian. This service has now safely maintained many patients at home who would previously been admitted to hospital. 

We have been lucky enough to have had many opportunities over the last few years to share our learning from our D2A project both at a local and national level. This sharing of knowledge has helped inform the creation of other D2A pathways across NHS Lothian as well as supporting improvements in both the stroke and orthopaedic pathways from acute Lothian sites back to East Lothian. Sharing our work has also given us lots of opportunities to enhance and broaden our professional and personal networks which has proved invaluable in our day to  day practice.

My top piece of advice for someone interested in completing  a similar project is: collect data, collect data, collect data. Both numbers but also patient and carer feedback. We did this from the start and it really helped build  our case for the success of the project and get further  funding to make the project permanent.

Interested in innovating?

Check out the Innovations in Physiotherapy database for more practical examples and guidance on how to submit your own work

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