Policies addressing delayed discharges from hospital in Germany

Abstract Background Two recent reforms in Germany's hospital sector are changes to hospital discharge management and the introduction of “transitional care” within hospitals. Discharge management was reformed under the 2015 Law to Strengthen Social Health Insurance Care. In November 2021, the Act for the Further Development of Healthcare introduced transitional care in German hospitals as a nationwide social health insurance benefit. Methods A review of academic and grey literature, media reports and organisational websites. Results Introduced in October 2017, the discharge management framework agreement (Rahmenvertrag Entlassmanagement) aimed to close care gaps after discharge by expanding hospitals’ ability to organise follow-up care and implementing a structured needs assessment. A multidisciplinary team of doctors, nurses and social workers coordinates after-care, with the nominated doctor holding final responsibility. Despite the additional bureaucratic workload, the law was generally seen as progress, as it expanded hospitals’ previously limited ability to arrange follow-up treatment and prescribe services. Hospital doctors can now prescribe medicines, bandages, remedies, aids, home nursing care and sociotherapy for up to seven days and certify work incapacity. Although the initiative has likely improved discharge management, no formal evaluations have been conducted. Regarding transitional care, treatment hospitals can offer a short-term stay of up to ten days per treatment if the necessary home nursing care, short-term care, medical rehabilitation services or long-term care cannot be provided immediately or would be considerably costly. No studies have evaluated this initiative, and some hospitals have not implemented it, raising questions about its effectiveness versus bureaucratic burdens. Conclusions Germany has adopted promising policies for addressing delayed discharges, but they come with increased bureaucratic workload and remain unevaluated.