Hospital discharge – everyone loses when its handled poorly

Dr Tom Nutt is Chief Executive of Healthwatch Essex and Dr Oonagh Corrigan led the hospital discharge research as Commissioning and Research Manager. Dr Alex Georgiadis is currently Acting Research and Commissioning Manager at Healthwatch Essex and co-authored the study. Healthwatch Essex tweets at @HWEssex

dischargeA major two-year research study undertaken by Healthwatch Essex into the experiences of patients discharged from three hospitals in the county has provided a comprehensive picture of this thorny issue. The report encourages local health and social care commissioners to overcome artificial boundaries and develop a unifying vision of care to provide high quality care.

The report, published at the end of last year, marks the organisation’s most ambitious project to date, involving almost 200 hours of observation and over 200 interviews with patients, staff, and family carers.

The key finding was that when the discharge process doesn’t work very well, everyone loses. The hospitals suffer from so called ‘bed blocking’, patients are put through unnecessary stress, and family carers find themselves having to pick up the pieces around ongoing support.

One of the core issues that impacted the discharge process again and again was poor communication. The Healthwatch Essex researchers found that in all too many cases both patients and family carers were not involved in the planning of discharge and follow-up support, which contributed to a lack of continuity of care and sometimes saw patients readmitted. Poor internal methods of communication often lead to staff frequently not having the right information regarding a patient’s readiness and needs for discharge.

Patients were often told different things by different members of staff regarding the timing of their discharge, which led to further delays, confusion and frustration for them and their family. They also found that some patients – particularly the elderly and those with little family or support – reported feeling under pressure to leave hospital before feeling ready to be discharged.

Delays on the day of discharge were also commonplace due to hold-ups in the delivery of take-home medication, hospital transportation and information such as letters for GPs and discharge or care plans.

Where assessments for care packages were required, delays could be exacerbated by a lack of coordination between health and social care and the shortage of care places in the community, care homes, nursing homes and re-ablement services.

The report outlines a series of recommendations for addressing the main issues. These include the introduction of rigorous systems to gather, store, retain and share information.

It was also recommended that all frontline hospital staff, and in particular staff working in wards with a high turnover of older patients, should receive mandatory training in hospital discharge planning.

Finally, looking to find new ways of informing the public about the care services offered in their locality and how and when to access them was highlighted as a way that increasing pressure on acute hospitals may be alleviated.

Healthwatch Essex has been pleased with the positive response to the report from local providers and commissioners, which has galvanised the whole system. Take a read for yourself by going to 

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