East Lothian Discharge to Assess service features in this month’s Frontline magazine

The Chartered Society of Physiotherapy’s Frontline magazine this month features a leading article on our Discharge to Assess service read full article below

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

The Innovations in Physiotherapy database is an online platform of quality assured examples that showcase innovation.


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

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


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

Developing a culture of ‘ownership’ of our East Lothian patients has enabled us to support patient flow and effect positive change on discharges.

Enhancing communication links between clinicians and services across community and acute sites has been crucial in building relationships and trust.

Developing a shared vision was a key part of our success.