Inappropriately delayed discharge from hospital: What do we know?

Vetter, Norman

doi:10.1136/bmj.326.7395.927

Cited by 43 publications

(34 citation statements)

References 13 publications

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“…We counsel caution in appropriating blame, remembering that a slow but safe and well-planned discharge is preferable to a swift sub-optimal one. 26 Solutions will be multi-faceted but would seem likely to include closer personalised working relationships between hospital and social service staff and investment to streamline the patient journey. Effective solutions will prevent delays in patient flow through both the acute admissions unit and base wards, will reduce iatrogenic delays, and will probably provide financial savings.…”

Section: Discussionmentioning

confidence: 99%

In-depth analysis of delays to patient discharge: a metropolitan teaching hospital experience

Hendy¹,

Patel²,

Kordbacheh

et al. 2012

Clinical Medicine

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-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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Section: Discussionmentioning

confidence: 99%

In-depth analysis of delays to patient discharge: a metropolitan teaching hospital experience

Hendy¹,

Patel²,

Kordbacheh

et al. 2012

Clinical Medicine

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“…Concerns have been expressed, however, about the unreliability of data at this aggregated level [1, 4,5]. We used local databases to explore the nature and extent of delayed transfers of older people in one primary care trust area (an administrative area for the provision of primary health and social services) in south-east England.…”

Section: Introductionmentioning

confidence: 99%

Delayed transfers of older people from hospital: Causes and policy implications

2006

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Health and social care agencies in the U.K. have been under pressure for some time to reduce delayed transfers of older people from hospital because they absorb scarce health service resources and incur a human cost through inappropriate placement. A local study based on an analysis of records and interviews with managers showed that delays reflect the complex needs of older people, and arise from financing and organisational problems at both the planning and implementation stages of a discharge. Family resistance may also be a factor. Budgetary constraints result in delays in confirming public support for some clients. Shortages of professional staff and care assistants limit the provision of domiciliary packages.The contraction of the residential sector has reduced the availability of beds and increased the cost of care home placements. Scope exists for expediting administrative aspects of transfers by coordinating health and social services. More recent legislation that imposes fines on social service departments for delayed transfers does not address underlying causes.(163 words)

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“…This compares with nine that we identified on a single day and compares with only one officially recorded delayed discharge patient. Vetter 14 emphasised the difficulties in assessing numbers of patients having delayed discharge with lack of definition, poor measurement tools and poor evidence. Urgent clarification of definitions is needed so that accurate and reproducible figures can be obtained.…”

Section: Discussionmentioning

confidence: 99%

A Waiting List to Go Home: An Analysis of Delayed Discharges From Surgical Beds

Benson

Drew

2006

annals

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INTRODUCTION The aim of this paper was to analyse patients who were unable to be discharged from a surgical ward despite being surgically fit to leave.PATIENTS AND METHODS Data were collected on all surgical in-patients on a single day. Patients who were surgically fit for discharge but whose discharge was delayed were identified. Demographic data and reasons for delay were noted.RESULTS Nine of 75 patients (12%) were surgical bed blockers. These patients were more likely to have been admitted as emergencies ( P = 0.035) and were older ( P < 0.01) than the remaining patients. They occupied 35% of the total 'bed-days' of the group as a whole with a median in-patient stay of 41 days compared with 2 days for the other patients. Trust-collected data, based on UK Government guidelines, showed only one surgical delayed discharge patient on the day studied.CONCLUSIONS Due to problems in defining delayed discharge Government figures probably underestimate the true numbers. Lack of intermediate care and social service provision are a major cause of bed blocking.

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Inappropriately delayed discharge from hospital: What do we know?

Cited by 43 publications

References 13 publications

In-depth analysis of delays to patient discharge: a metropolitan teaching hospital experience

In-depth analysis of delays to patient discharge: a metropolitan teaching hospital experience

Delayed transfers of older people from hospital: Causes and policy implications

A Waiting List to Go Home: An Analysis of Delayed Discharges From Surgical Beds

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