Delayed Discharges and Hospital Type: Evidence from the English NHS

Abstract

Delayed discharges of patients from hospital, commonly known as bedblocking, are a long-standing policy concern. Delays can increase the overall cost of treatment and may worsen patient outcomes. We investigate how delayed discharges vary by hospital type (Acute, Specialist, Mental Health, Teaching) and the extent to which such differences can be explained by demography, case mix, hospital quality, the availability of long-term care, and hospital governance as reflected in whether the hospital has Foundation Trust status, which gives greater autonomy and flexibility in staffing and pay. We use a new panel database of delays in all English NHS hospital Trusts from 2011-12 to 2013-14. Employing count data models, we find that a greater local supply of long-term care (care-home beds) is associated with fewer delays. * Submitted December 2015. 496 Fiscal StudiesHospitals that are Foundation Trusts have fewer delayed discharges and might therefore be used as exemplars of good practice in managing delays. Mental Health Trusts have more delayed discharges than Acute Trusts, but a smaller proportion of them are attributed to the NHS, possibly indicating a relatively greater lack of adequate community care for mental health patients. Policy pointsr Foundation Trusts have fewer delayed discharges and might therefore be used as exemplars of good practice in managing delays.r Mental Health Trusts incur more delays with a higher proportion outside the control of the NHS. This may indicate unmet need for mental health patients, and possible lack of coordination over provision of social care.r Greater local provision of long-term care beds in care homes reduces delayed discharges in hospitals, confirming the importance of coordinating health and social care.

Impact and experiences of delayed discharge: A mixed‐studies systematic review

“…This is the first systematic review of the literature to take a comprehensive perspective on the impact of delayed discharge on patients, staff, and hospitals; and of their interrelationships . For patients, the main adverse outcomes are an association with an increased risk of mortality, hospital‐acquired infections, mental ill health and reductions in patients’ mobility and activities of daily living.…”

“…Delayed discharge is an important problem for health‐care providers internationally . It is defined as the period of continued hospital stay after a patient is deemed medically fit to leave hospital but is unable to do so for non‐medical reasons .…”

“…It is defined as the period of continued hospital stay after a patient is deemed medically fit to leave hospital but is unable to do so for non‐medical reasons . Costs to the National Health Service (NHS) in England associated with delayed discharge are approximately £100 m per year and resulted in 1.2 million bed‐days lost in 2013‐14 . A Canadian study found that between 8 and 10% of beds in acute hospitals were occupied inappropriately by delayed patients…”

Predictive model of length of stay in hospital among older patients

“…Discharge delay has been shown to be influenced by socioeconomic and policy factors as well as decision-making process between interdisciplinary team members and patients [ 20 ]. A study by Gaughan et al [ 21 ] has indicated that fewer delayed discharges were associated with hospitals with Foundation Trust status (semi-autonomous organisational units within the NHS in England which have a degree of independence from the Department of Health to decide locally how to meet their obligations) and a greater local provision of long-term care home beds. Analysis of clinical data such as those collected by clinical audits or registry-based clinical trials is an integral part of the delivery of care quality to identify and address factors associated with readmissions [ 22 ] and prolonged LOS [ 23 ].…”

The Challenges of Public Financing and Organisation of Long‐Term Care

“… James Gaughan, Hugh Gravelle and Luigi Siciliani investigate whether delayed discharges of patients from hospital, commonly known as bed‐blocking, vary by hospital type. They find that hospitals in England with Foundation Trust status, which gives them greater financial autonomy and flexibility, have fewer delayed discharges.…”