Background Many patients nearing the end of life (EoL) express a wish to be cared for outside the acute hospital environment. However, hospital discharge processes often cannot offer a quick transfer, with the result that valuable time is lost for the patient and their family. This, along with the national need for Trusts to save acute bed days, were drivers for the introduction of a Macmillan discharge pilot project at one acute hospital.

Aim To identify the experiences of professional staff and carers who had been involved with the new service. To inform future developments of the service.

Methods An action research approach informed the study design. Data was collected through seven focus groups and two individual interviews with professional staff from the hospital and community (n=53) and interviews with six carers. Data was thematically analysed using the approach of Braun and Clark (2006).

Results A key finding was how small the window of opportunity was for achieving a good EoL discharge. This window formed part of a discharge continuum that not only comprised a rapid transfer from hospital but started with timely communication with patients and their families regarding preferred place of care. The new service brought a more co-ordinated approach along this continuum which made an impact on the timeliness of the discharge process. Aspects where improvements could be made were identified from the data and informed an action plan which was devised by the service.

Conclusion A complex mesh of factors need to be drawn together to effect a good discharge. This requires an emphasis on co-ordination combined with expertise in EoL care. The new service was successful in promoting a good discharge for many patients. However, further development of the service is needed so that more patients are able to achieve their preferred place of care.