Jann Niklas Vogel¹, Hanna Hilgenhof¹, Ivonne Honekamp¹, Anne Petereit², Valerie Bühler², Chiara Kleinschmidt², Stefan Schmidt²

¹ Department of Health, Nursing and Management, Neubrandenburg University of Applied Sciences

² School of Economics, Stralsund University of Applied Sciences

Background: Discharge management constitutes a central, time-critical interface in healthcare, where shorter lengths of stay, institutional processes and legal frameworks intersect with limited post-hospital care structures. In rural areas, these challenges are further exacerbated by geographical distances. Timing issues between inpatient, outpatient and community care compromise continuity of care, prevention and participation in healthcare, and are therefore ethically significant.

Methodology: This article is based on a joint project, running until September 2026, investigating discharge management and follow-up care in rural areas of Mecklenburg-Western Pomerania. The methodology follows a mixed-methods design. First, a scoping review was conducted, followed by guided focus group discussions with regional stakeholders from healthcare, nursing, social work, administration and civil society. This was followed by a standardised, state-wide questionnaire survey of all hospitals in the Federal State. To gain further insight, additional focus group discussions were held using the structural mapping technique. Furthermore, follow-up individual interviews with patients and key stakeholders in the healthcare sector are planned for spring 2026.

Results: Analyses to date suggest that in rural areas, local transitional, short-term and day care services are sometimes lacking, making it difficult to organise follow-up care in a timely manner. Heterogeneous communication structures and unclear responsibilities lead to delays in the care process. These time-related discrepancies contribute to gaps in care, prolonged hospital stays or transfers to more distant facilities, and particularly affect older people and those with complex care needs. At the same time, regional resources have been identified that support improved coordination of care timing.

Conclusion: The results illustrate that discharge management in rural areas has not only organisational but also ethically relevant dimensions. Time proves to be a key care resource, the availability of which is a decisive factor in ensuring continuity of care and participation in healthcare.