We aimed to understand clinical decision-making processes that influence the orientation of older patients after hospital discharge. We compared discharge decisions (i.e., discharge home, or nursing home stay) of the hospital team with those of an expert panel. Both panel and hospital team made their decisions independently. The blind study included 102 patients (mean age: 83.13 ± 6.74). There is a statistically significant difference between expert and hospital team decisions (p < .001; kappa coefficient: 0.468). Panel decisions were more closely associated with isolation (p = .018), reliable caregivers (p = .004), social problems (p = .001), and behavioural symptoms perceived as aggressive (p = .001). Both decision processes considered refusal of care (p = 0,025 and 0.016 respectively) and social problems (p = .001 and < 0.001 respectively). Discharge planning models differ depending on the country, team and patient’s condition. Our study suggests more precise evaluation of patients’ needs.

Objective: To identify the barriers to successful discharge practices in a general hospital medical service.

Design: Focus groups with health professionals and in depth interviews with patients were used to identify and explore themes arising from the concept of a good discharge. Thematic analysis was undertaken to identify and link the concepts highlighted.

Subjects: Four focus groups (four to ten participants) and ten in depth interviews were conducted. Purposive sampling was used to capture a full range of views.

Main outcome measures: Themes arising from the focus groups and interviews were analysed to examine barriers to effective discharge practice.

Results: Five major themes emerged from the focus group data including; 1) Communication, 2) Teamwork and Roles, 3) The process of discharge and co-ordination 4) Resources, and 5) Time. Patients discussed their experiences, concerns and lack of knowledge, of the discharge process.

Conclusion: The barriers to influencing the discharge process were shown to be complex and interrelated. The way, in which teams work together is an important factor, which appears not to have been addressed in research into discharge interventions. No single strategy or intervention is likely to be successful in changing discharge practice. Future research to improve discharge should focus on combinations of strategies that target local barriers at the level of the individual, team and organization.