-Delayed patient discharge will likely exacerbate bed shortages. This study prospectively determined the frequency, causes and potential cost implications of delays for 83 consecutive patients, who were inpatients for a total of 888 days. 65% of patients experienced delay whilst awaiting a service. 48% of patients experienced delays that extended their discharge date. Discharge delays accounted for 21% of the cohort's inpatient stay, at an estimated cost of £565 per patient; 77% of these hold-ups resulted from delays in the provision of social and therapy requirements. Discharge delays are costly for hospitals and depressing for patients. Investment is required to enable health and social-care professionals to work more closely to improve the patient journey. KEY WORDS: delayed discharge, patient experience, patient journey, Quality, Innovation, Productivity and Prevention (QIPP) agenda IntroductionThe NHS is increasingly criticised for bed shortages, delayed elective admissions and long waiting lists. 1 The number of admissions to secondary care in the UK is growing year-on-year 2 because of limited out-of-hours services in primary care, a greater number of patients who expect proactive hospital care and, most significantly, an increasing population of older people. Older patients are often frail and have complex social and healthcare needs, resulting in a prolonged inpatient stay. 3 At the same time as hospital admissions have increased, there has been a decrease in the number of hospital inpatient beds. 4 This has been off-set by efficiency directives, with a reduction in the average inpatient stay from 11.7 days in 1980 to 6.8 days in 2000. 5 One hospital has recently reported a reduction in average inpatient stay to 5.3 days, coincident with the introduction of twice-daily consultant ward rounds. 6 Nevertheless, demand frequently outstrips supply. Hospitals are often 'full' , with deleterious effects that include delayed patient flow, failure of specialty ward-based hospital systems and delayed or cancelled elective admissions.Bed pressures are increased by 'delayed discharges' , which exacerbate patients' exposure to hospital-acquired infections, low mood and increasing loss of functional capacity. Remedying such delays would provide both cost savings and better quality of care, in line with the NHS Quality, Innovation, Productivity and Prevention (QIPP) agenda.The aims of this longitudinal prospective study were to determine the length of inappropriate delay experienced by patients in a general medical ward prior to discharge, to identify common causes of delay and to estimate the financial implications of discharge delays. MethodsThe Chelsea and Westminster Hospital, London, admits both medical and surgical patients to an acute admissions unit (AAU), from which 60% are discharged home within 48 hours. The remainder are transferred to base wards. The majority of these patients require specialist elderly care that cannot be provided by single organ specialists.For seven weeks beginning 12 October ...

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Policy Manager, Inter-Governmental Relations Unit, NSW Cabinet Office COAG was formed out of a concern by commonwealth, state a d territory governments to improve intergovernmental cooperation. In particular, COAG allowed leaders and central agencies to discuss and coordinate policy frameworks from a whole-of-government perspective. It also has increased the prospects of further reform to Australia's political system in the areas of financial arrangements, international treaties and constitutional refom.The views expressed are personal and do not necessarily reflect those of the NSW Cabinet Office.

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A Ingham, J Graham and P Hendy Current intelligent network (IN) platforms support high capacity real-time call processing applications, tuned to provide virtually instant service, and with comprehensive network overload control schemes to cope with huge (often media stimulated) traffic spikes. In order to meet these requirements, IN platforms tend to be 'stove-pipes' (platforms dedicated to a specific service). BT's aim is to deploy a zero-touch, self-service platform supporting all services. BT's proposed 21st century architecture has determined that the intelligence space and the systems space shall converge. This convergence poses some serious challenges for the performance engineer.Does the converged intelligence layer need to provide performance equal to, or better than, the current platforms? Or will end users tolerate a degradation, if the price is right? How can stringent performance requirements actually be met in a converged intelligence space, with its rich new service features? This paper discusses the issues, and potential solutions.