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News Article
Ministers to set up ‘dedicated team’ to aid NHS recovery
Patient Safety Learning posted a news article in News
The government said it will set up ‘dedicated team’ to look for innovative ways for the NHS to continue treating people for coronavirus, while also providing care for non-covid health issues. In its pandemic recovery strategy published today, the government also said step-down and community care will be “bolstered” to support earlier discharge from acute hospitals. The 60-page document contained little new information about plans for NHS services, but said: “The government will seek innovative operating models for the UK’s health and care settings, to strengthen them for the long term and make them safer for patients and staff in a world where COVID-19 continues to be a risk. “For example, this might include using more telemedicine and remote monitoring to give patients hospital-level care from the comfort and safety of their own homes. Capacity in community care and step-down services will also be bolstered, to help ensure patients can be discharged from acute hospitals at the right time for them". To this end, the government will establish a dedicated team to see how the NHS and health infrastructure can be supported for the COVID-19 recovery process and thereafter. Read full story Source: 12 May 2020 -
News ArticleThe next few months will be full of grim updates about the spread of the new coronavirus, but they will also be full of homecomings. Patients hospitalised with severe COVID-19, some having spent weeks breathing with the help of a mechanical ventilator, will set about resuming their lives. Many will likely deal with lingering effects of the virus — and of the emergency treatments that allowed them to survive it. “The issue we’re all going to be faced with the most in the coming months is how we’re going to help these people recover,” says Lauren Ferrante, a pulmonary and critical care physician at the Yale School of Medicine. Hospital practices that keep patients as lucid and mobile as possible, even in the throes of their illness, could improve their long-term odds. But many intensive care unit doctors say the pandemic’s strain on hospitals and the infectious nature of the virus are making it hard to stick to some of those practices. Read full story Source: Science, 8 April 2020
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News Article
We need a Nightingale model for rehab after COVID-19
Patient Safety Learning posted a news article in News
A major new model of post-acute care is needed for the discharge and rehabilitation of patients following COVID-19 infection, say Alice Murray, Clare Gerada, and Jackie Morris. A comprehensive plan must be made for the 50% of COVID-19 patients who will require some form of ongoing care following admission to intensive care, with the goal of improving their long-term outcomes and freeing-up much-needed acute hospital capacity. While the current focus is quite rightly on emergent cases, planning should be set in place to create post-acute care resources and facilities for the surge in numbers of people with the physical, psychological and functional consequences of prolonged ITU stays and or hospital admission following COVID-19 infection. One potential solution is to provide mass facilities, on a scale to match the Nightingale Hospitals in so-called “Centres of Excellence”, requisitioned for those who survive but need care and cannot return to their own homes, with both residential and day care units available. Read full story Source: HSJ, 9 April 2020 -
News Article
Cornwall hospital to discharge patients early despite saying it may be harmful
Patient Safety Learning posted a news article in News
A major NHS hospital is under such pressure that it has decided to discharge people early even though it admits that patients may be harmed and doctors think the policy is unwise. The Royal Cornwall Hospitals NHS trust has told staff to help it reduce the severe overcrowding it has been facing in recent weeks by discharging patients despite the risks involved. In a memo sent on 8 January, three trust bosses said the Royal Cornwall hospital in Truro, which is also known as Treliske hospital and has the county’s only A&E department, “has been under significant pressure for the last two weeks and it is vital that we are able to see and admit our acutely unwell patients through our emergency department and on to our wards”. The memo added: “One of these mitigations was to look at the level of risk that clinicians are taking when discharging patients from Treliske hospital either to home or to community services, recognising that this may be earlier than some clinicians would like and may cause a level of concern. “It was agreed, however, that this would be a proportionate risk that we as a health community were prepared to take on the understanding that there is a possibility that some of these patients will be readmitted or possibly come to harm.” Read full story Source: 14 January 2020 -
Content ArticleThis analysis in the Financial Times highlights that in early April 2022, the number of vacant NHS hospital beds in England was 5.4%, the lowest figure since the start of the Covid-19 pandemic. The joint pressures of dealing with the backlog of elective care and ongoing high rates of Covid-19 infections are leaving the health service dangerously close to capacity. The authors highlight that this is likely to cause longer waits in accident and emergency and the potential for patients to be sent to wards that cannot effectively cater for their needs.
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Content ArticleOut-of-hours discharge from the intensive care unit (ICU) to the ward is associated with increased in-hospital mortality and ICU readmission. This study in the journal Critical Care Medicine was part of the REcovery FoLlowing intensive CarE Treatment mixed methods study. It aimed to map the discharge process and describe the consequences of out-of-hours discharge to inform practice changes to reduce the impact of discharge at night. The study identified significant limitations in out-of-hours care provision following overnight discharge from ICU. The authors recommend changes to help make daytime discharge more likely, and new systems to ensure patient safety where night time discharge is unavoidable.
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Content ArticleThis long read by the Health Foundation examines the challenges of discharging people from hospital, and looks at 'discharge to assess' (D2A) an approach to reducing the incidence of delayed discharge. It outlines priorities for policymakers and the NHS and suggests next steps for managing hospital discharge.
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Content ArticleMedication errors are common at the hospital discharge transition but there’s a lot we can do to improve this. The Royal College of Physicians have developed resource focusing on medication safety at hospital discharge that takes teams through the quality improvement process step-by-step. The project was developed in close consultation with a multidisciplinary task and finish group and with input from across health and social care, including patient and carer representatives. This enabled a better understanding of problems that cross sector boundaries, such as medication safety at the hospital discharge transition, and ensured the problem was approached from multiple perspectives. The guide and accompanying improvement tool templates are available to download below.
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Content ArticleThis article examines the challenges in regulating patient safety during hospital discharges in England through the lens of liminality. In addition, this article proposes that by positioning the new role of Patient Safety Commissioner (PSC) as that of a ‘Representative of Order’, it could be a means by which this poorly regulated space could be navigated more successfully.
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Content Article
The Integrator: The discharge debacle (HSJ, 13 January 2022)
Patient Safety Learning posted an article in Discharge
HSJ’s inboxes are currently heaving with frustration and fury on a rare consistency of theme; the build up of medically fit patients who can’t be discharged from hospitals. Here’s one example from an exasperated, experienced manager, who spoke of “real failure in social care – long stays growing and no capacity to discharge to, a. Homes closed due to infection, b. Homes going out of business c. Homes unable to come and assess patients as no spare staff, d. No care packages as staff sick or none available due to lack of capacity e. social workers and others needed to make assessments in very short supply”. “We keep getting told we’ll cope and get through but we’re really not… The will to continue is beginning to break down with refusals to redeploy and high sickness absence on top of enforced absence due to covid. A seemingly mad commitment to grind through elective stuff… -
Content ArticleA delayed discharge is when a patient no longer requires hospital care but isn’t able to leave. Earlier this winter, hospital trusts in England were asked to work with local partners to cut delayed discharges by half by the end of January. Natasha Curry and Liz Fisher show how the situation has actually got worse since, and discuss the possible reasons why.
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Content ArticleChanging our services so that more care is provided in community settings and people can leave hospital when they are fit for discharge has been an explicit policy aim for decades. Other, similar countries have been on the same mission and have had more success. Why might this be? This new analysis from the Nuffield Trust looks internationally at how our performance compares and how other countries have succeeded in building up community health and care services to understand what England might learn.
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Content ArticleA report has been published by Healthcare Inspectorate Wales (HIW) setting out the findings of a review of patient flow in Wales. Patient flow is the movement of patients through a healthcare system from the point of admission to the point of discharge. HIW specifically examined the journey of patients through the stroke pathway. This was to understand what is being done to mitigate any harm to those awaiting care, as well as to understand how the quality and safety of care is being maintained throughout the stroke pathway.
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Content ArticleCommunity hospitals play a very important role in supporting patients but, unlike with larger hospitals, little has been known until now about how they struggle with delayed discharges. Following a freedom of information request, the Nuffield Trust reveals the number of patients experiencing delays leaving community hospitals, and highlights the capacity challenges such hospitals face.
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Content ArticleDelayed discharges, where a patient is medically fit to leave hospital but is not discharged, were a particular problem in England in the winter of 2022/23. In this article, Camille Oung from the Nuffield Trust highlights some possible solutions to help better prepare health and care services for discharge pressures next winter.
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Content ArticleThe eDischarge Information Record Standard was first published in 2015. Despite significant investment in programme initiatives, the widespread implementation of the standards has been slow. In this report from the Professional Record Standard Body, authors identify the challenges that have inhibited the adoption of the standard, make recommendations for improvements and set out the anticipated benefits that this will bring. The aims of this discovery and user-design phase were: To review the current state of adoption of transfer of care messages between secondary care senders and primary care receivers of transfers of care and identify reasons for the low uptake to date. To understand GP’s needs and priorities for computer readable data that can be shared with primary care systems without loss of meaning. To make recommendations for what needs to happen to enable widespread adoption that supports the needs of GPs to deliver safer patient care.
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Content ArticleSuccessful day surgery requires a day surgery team with the correct knowledge and skills to enable safe, early recovery and discharge but there is an absence of national guidance on supporting competencies. Applying in-patient competency criteria is inappropriate as this pathway is not aimed at promoting early discharge. This joint publication between AfPP and BADS (the British Association Of Day Surgery) provides recommendations for core competencies for adult day surgery through (1) admission, (2) anaesthetic room, (3) theatres, (4) first-stage recovery and (5) second-stage recovery and discharge. They are relevant for staff new to or after a long absence from day surgery and acknowledge some members of the day surgery team may include non-registered practitioners. All can be used as a reference for workbook competency documents in place or in development.
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Content ArticleA key piece of guidance aiming to support hospital teams in their work to improve care of older people living with frailty is now available, in a collaboration between Getting It Right First Time (GIRFT) and the British Geriatrics Society (BGS). The guidance is designed to accompany the new GIRFT Hospital Acute Care Frailty Pathway, and offers detailed measures teams should take to improve care and reduce hospital-acquired dependency for those living with frailty, as well as stressing that interventions should be monitored and linked more widely to community-based services.
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Content ArticleThis report examines the reporting of patient deaths at the Norfolk and Suffolk Foundation NHS Trust (NSFT) between April 2019 and October 2022. It was undertaken by Grant Thornton on behalf of the NHS Suffolk and North East Essex and NHS Norfolk and Waveney integrated care boards at NSFT’s request.
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Content ArticleOver the two decades before the pandemic, the number of NHS patients admitted to hospital increased year-on-year, despite a reduction in the number of hospital beds. Since the Covid-19 pandemic, fewer patients have been admitted to NHS hospitals and length of stay has risen, raising questions about NHS productivity, quality of care and the prospects of meeting ambitions to recover services. This report by the Health Foundation analyses data around hospital admissions and suggests reasons for these trends.
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Content ArticleHospitals can significantly elevate patient satisfaction and enhance the delivery of healthcare services by incorporating best practices from adjacent and non-adjacent sectors. Chetan Trivedi explores several solutions, from multiple sectors, that can serve as a blueprint for hospitals across every key step of the patient journey, spanning from admission to discharge.
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Content ArticleThis white paper from CEMBooks aims to unpick some of the deeper issues surrounding bed block and emergency department crowding from the perspective of a frontline medic with two decades of emergency and flow management experience. It aims to provide a greater understanding of the factors influencing the current situation and the measures used to define it followed by some practical implementable solutions.
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News Article
Number of patients 'medically fit' to leave hospital increases
Patient Safety Learning posted a news article in News
The number of patients in hospitals who are ‘medically fit’ to leave has increased in January, despite NHS England targets for trusts to dramatically reduce the numbers. Internal data seen by HSJ suggests there were an average of 12,819 patients who no longer met the ‘criteria to reside’ in NHS hospitals in the week to January 23 – up from around 10,500 before the Christmas period. Last month, NHS England told local systems to dramatically reduce their numbers of medically fit patients who remained in hospital, as they aimed to free up beds amid a surge in covid-19 admissions fuelled by the omicron wave. It told local leaders “a significant proportion of discharge delays are within the gift of hospitals to solve”. The message was reiterated by NHSE’s regional teams at the start of January, with systems told to reduce their numbers of medically fit patients by between 30 and 50 per cent. Yet the proportion of ‘medically fit’ for discharge patients occupying NHS general, acute or critical care beds has also been rising, from around 12% in December to around 14% in mid-January. Delayed discharges are frequently cited as the main cause of long delays for patients being admitted through hospitals’ emergency departments, which have significantly worsened in recent months. Read full story (paywalled) Source: HSJ, 26 January 2022 -
News ArticleNHS England has encouraged trusts to consider taking legal action against patients who refuse to leave hospital beds when step-down care is made available. NHSE guidance sent to trusts late last year, seen by HSJ, advised clinicians that where people “with mental capacity” refuse to vacate a bed because they do not accept NHS-funded short-term care offers, the “local discharge choice policy” should be followed, which could involve legal action. The guidance said the process “may include seeking an order for possession of the hospital bed” under civil law, and that “appropriate formal notification of the process must be given to the person and their representatives/carers”. These legal powers were open to trusts prior to covid, but the memo from NHSE comes amid increasing pressure on trusts to improve discharge rates, as waits for emergency and elective care continue to soar. Helen Hughes, chief executive of Patient Safety Learning, said: “Given the current pressures posed by covid, it is understandable that the NHS is seeking to ensure that the hospital discharge process is as swift and effective as possible. “However, hospital discharges are complex processes and can potentially result in avoidable harm if patients are discharged before they are clinically ready. It only takes one element of this complex process failing to put a patient’s safety at risk. “We would be particularly concerned if patients and their carers were put under pressure to accept potentially unsafe discharge options due to the threat of possible legal action by an NHS trust.” Read full story (paywalled) Source: HSJ, 14 January 2022
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News ArticleHospitals across Kent, Sussex and Surrey are being asked to discharge hundreds of patients who are well enough to leave by Friday. The head of NHS South East, Anne Eden, said the beds are needed to deal with an expected surge in admissions of people ill with the Omicron variant. The NHS nationally has agreed to a reduction of 30% of such patients based on the baseline figure of 13 December. South East hospitals are being asked to make a 50% reduction by 31 January. In a letter seen by the BBC, Ms Eden said: "This is in order to create the headroom to manage any further Covid pressures, with current modelling indicating a peak in Covid activity in mid-January." She wrote: "It is now critical that we redouble our efforts to discharge those patients who no longer require bedded care, to create capacity, improve flow and reduce the pressure on staff." Ms Eden said staff absences and the need to maintain delivery of critical care for patients mean the NHS "must continue to focus on creating the necessary capacity to meet demand". "Failure to do this will significantly increase the risk of a further rise in patient harm," she said. She said hospitals must work with partners, including social care providers, to achieve the reduction in the number of patients in hospital who were well enough to be discharged. Read full story Source: BBC News, 10 January 2022
