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

A 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.

Get healthcare providers to improve care together, that’s the challenge

Noor Heim is an assistant professor who currently works for the University Medical Center in Utrecht. In this blog, she discusses her recent Age & Ageing paper on research she has done in the Leiden University Medical Center.

Integration of treatment and care from multiple disciplines is particularly critical in care for older people. Most older people admitted to a hospital suffer from more than just one (chronic) condition. As a consequence, coherent care for older patients involves more than just one discipline. Furthermore, the fact that patients are discharged from hospital quicker and sicker, with higher demands of care, increases the need for integration of (transitional) care between settings. Given the number of older adults who permanently lose the ability to perform one or more activities of daily living during and after a hospital admission, one has to conclude things need to be improved. However, it has proven challenging to accomplish improvements and maybe even harder to study (and to quantify) the benefits of the efforts taken.

Systematic review of Emergency department community transition strategies

Judy Lowthian is a researcher at Monash University’s School of Public Health and Preventive Medicine. Here, she discusses a new systematic review published in Age & Ageing, which looks at various emergency department community transition strategies (ED-CTS) to determine their efficacy.

Emergency Department patients aged 65 years and over are increasing at a faster rate than the ageing population. These older individuals have longer stays in the emergency department and a higher chance of admission due to various psychosocial and medical problems. They also often need increased resources to better comprehend their reason for presentation. Clinicians are also under the strain of meeting time-based targets, managing the flow of the emergency department, maintaining adequate quality of care and accounting for appropriate resource allocation.

A Naïve Junior Doctor’s Opinion on “Admission Avoidance”

Daniel Sommer is a Foundation Year 2 Doctor at Charing Cross Hospital in London. He is an aspiring Geriatrician. He tweets at @danielf90 

Hello everyone, my name is Dan and I’m a junior doctor and an aspiring geriatrician (read my last blog post here). My new job is working as part of my hospital’s OPAL (Older Peoples’ Assessment & Liaison) team and I absolutely love it. We run a rapid access day clinic that GPs refer into and we review every patient over the age of 70 who is on the acute medicine unit routinely (usually after the consultant post-take ward round but sometimes we’re asked to intervene earlier). I felt compelled to write something about admission avoidance in the elderly because I hear so much about it in the media and my working experience does not correlate with what I read.

Overnight Hospital Discharges

Chris Roseveare is a Consultant Physician in Acute Medicine at University Hospitals Southamption, and is Editor of Acute Medicine Journal. He tweets at @CRoseveare. Here he discusses a recent report from Sky News: Hundreds Discharged From Hospitals Every Night

news.sky.com

It’s 2am on a Sunday in a hospital in the UK, and the duty consultant physician has just been called in. It has been a difficult weekend for the medical team: the Acute Medical Unit (AMU) was already full on Saturday morning following a busy Friday night. Compounding this, the locum agency were unable to fill the SHO vacancy on Saturday and the foundation year 1 called in sick for her night shift. Sunday had started with 15 medical patients waiting to be clerked in the Emergency Department (ED), and the medical team have struggled all day to clear the backlog. Ambulance trolleys are now queued in the corridor in the ED; there are ten patients who have waited more than four hours for a bed in the AMU, two of whom are approaching a twelve hour wait. Beds have been opened – and filled – in the managed care unit as well as the medical ambulatory care area. More than 20 patients have been ‘outlied’ into the surgical division during the course of the weekend, which has necessitated cancellation of a number of elective surgical admissions planned for surgery tomorrow. There no longer seems to be any room for manoeuvre.

In consultation with the on-call executive, the duty manager now has a plan: several patients have been identified across the hospital whose discharge is planned for Monday morning – perhaps if they could be discharged from hospital overnight this could help ease the pressure in the ED….? The medical consultant is on her way into the hospital. This will be a difficult discussion.

A recent report on Sky News suggested that ‘over 300,000 patients’ had been discharged from hospital overnight since 2012, including over 60,000 who were over 75.

Identifying frailty and its outcomes

Elsa Dent is a researcher at the University of Adelaide specialising in Nutrition and Ageing.

People differ vastly in the way they age. If we are able to predict which individuals are likely to face problems as they age, we may be able to use this information to design preventative programs and to optimise a person’s care and treatment.

One way to identify older people at risk of poor outcomes is by identifying frailty. Frailty is a common condition in older people, although it is not an inevitable part of ageing. It is characterised by weakness, weight loss and a decreased ability to cope with illness and life challenges.