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For patients approaching the end of life in hospital, returning home may feel out of reach, particularly when they require intensive medical support. HCA Hospice’s Compassionate Discharge (ComD) service helps make this possible.
ComD is an urgent, one-way transfer for hospitalised patients in their final moments, enabling them to return home to spend their remaining time in a familiar and comforting environment. HCA Hospice was the first organisation to develop Singapore’s national ComD framework, which has since been standardised across healthcare institutions. Today, HCA remains the only organisation in Singapore facilitating round-the-clock ComD, including weekends and public holidays.
Our team works closely with families, hospitals and referring doctors to coordinate the transition from hospital to home, while ensuring that patients continue to receive the care and symptom management they need.
When going home seemed impossible
For Senior Resident Physician Dr Shariff Rizwan, one case remains particularly memorable.
The patient had severe respiratory failure and was in the ICU, requiring a high level of medical support. She remained intubated and, under usual circumstances, returning home might have seemed impossible.
Through HCA’s ComD service, the team coordinated her transfer home on a portable ventilator. The plan was for her breathing tube to be removed at home, surrounded by the people and environment that were most familiar to her.
“What stayed with us most vividly was the moment the patient arrived home,” Dr Shariff shared.
Despite the medical complexity of the situation, something changed when the patient returned to her familiar surroundings. Surrounded by her loved ones, with family members singing to her, she opened her eyes and smiled.
“For a brief but precious time, the medical intensity of the situation seemed to give way to something gentler and more personal: not just a critically ill patient being cared for, but a person returning home to the voices, presence, and love of family.”
Making the complex possible
Getting the patient home required close coordination and intensive medical support. The case took place on a particularly busy day across HCA’s satellite offices, but the team came together to make the transfer possible.
Once home, the patient continued to require active symptom management, including urgent medications and an infusion to keep her comfortable. Although the care remained intensive, being at home allowed her to remain calm and comfortable.
She passed away peacefully a few days later, with her loved ones by her side.
For the family, being able to spend that time together at home was something they had never imagined would be possible.
A family member later visited the HCA office personally to thank the team. They shared that, given the patient’s need for intubation and high level of medical support, they had never expected to be able to bring her home. Without the support of HCA’s ComD service, particularly over the weekend – they felt this precious time together would likely not have been possible.
Creating impact beyond the bedside
ComD is first about bringing patients home, but its benefits extend well beyond them. HCA Hospice partnered with National University Hospital (NUH) on its Harmonised Compassionate Discharge (ComD) Pilot to explore how a coordinated ComD model could support both patient-centred care and the wider healthcare system.
Across the 14 patients enrolled in the pilot, the ComD workflow released 63 acute inpatient bed days that would otherwise have been occupied by patients awaiting transition to home-based end-of-life care. These beds could then be made available to patients requiring inpatient medical treatment and higher-intensity care.
More than a transfer
Compassionate Discharge is more than moving a patient from one place to another. It is about creating the possibility of dignity, connection and comfort when time is limited.
Every discharge involves careful planning between the hospital team, HCA’s clinical team – comprising doctors, nurses and medical social workers – as well as the Data, Innovation and Research Team, the patient and their family. From coordinating transport and medical equipment to preparing medications and supporting symptom management at home, our teams work together to make the transition as seamless as possible.
And because these moments do not always happen during office hours, HCA’s ComD service operates 24/7, including weekends and public holidays.
For Dr Shariff and the ComD team, being able to support patients and families through these moments is a privilege.
“It allows patients and families to have moments of dignity, connection, and comfort in a place that is deeply personal to them.”
Sometimes, creating a good day means making it possible for someone to come home.
And sometimes, home is exactly where they need to be.
