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Found 167 results
  1. News Article
    NHS trusts have been unable to get anywhere close to the target for reducing delayed discharges set by NHS England last month ahead of the omicron wave. The latest NHSE data shows that, in the week beginning 27 December, there were on average 9,857 medically fit for discharge adult patients occupying hospital beds. This is just 836 fewer than the average of 10,693 in the week of 13 December. This was when NHSE told trusts to discharge at least half of their medically fit patients to free up beds ahead of a surge in Covid patients. The news follows ministers announcing £300m would be invested into the adult social care workforce to fund community placements to aid discharges. However, in the letter on 13 December, NHSE said “a significant proportion of discharge delays are within the gift of hospitals to solve”. Meanwhile, ambulance handover delays remained a near record high levels last week as the urgent and emergency care system showed clear signs of pressure, including massive demand on NHS 111. Read full story (paywalled) Source: HSJ, 7 January 2022
  2. News Article
    A care home with some of the highest Covid death rates recorded in the pandemic is facing whistleblower claims over unsafe conditions. Golfhill Nursing Home, in Dennistoun in Glasgow's East End, Scotland, is run by Advinia Healthcare, which confirmed a "large scale" investigation was taking place. A report by the Crown Office, published in April, showed Golfhill care home recorded 11 deaths related to coronavirus, among the highest rates. The Care Inspectorate investigation is said to have followed "months of complaints" about sub-standard and unsafe conditions at the home, including residents being admitted to hospital suffering from dehydration. The problems are said to centre on the intermediate care unit, where elderly residents are transferred after being discharged from hospital, requiring a higher level of care and remaining there for around a month before being sent home or into long-term care. According to a source, the unit has been short staffed "almost on a daily basis" because employees were being transferred to other areas of the home. Read full story Source: The Scotsman, 17 December 2021
  3. News Article
    Nursing shortages are allowing “profiteering” staffing agencies to triple their rates, care leaders have warned, raising the risk of vulnerable patients being forced to move care homes and increasing the burden on the NHS. The crisis is forcing some nursing homes to become standard residential care homes without support for people with chronic diseases. The shortage also makes it harder for NHS hospitals to discharge patients. Some hospitals have redeployed their own staff into nursing homes to free beds in hospitals. In other places, NHS trusts are competing for staff with care providers. Geoff Butcher, director of Blackadder Corporation, which runs six homes in the West Midlands, said that he paid nurses about £19.50 an hour, slightly higher than the NHS rate of £16.52. “Two of our nurses resigned recently and they’ve gone to an agency for £35 an hour,” he said. “And that agency then came to us and said we can have these staff back at £52 an hour. They want £95 an hour for those nurses on a bank holiday nightshift. It’s utterly unaffordable. “Because the NHS can’t recruit they are having to use these agencies as well. So the NHS is bidding against us, therefore they’re pushing the rates up, and the whole thing has gone into a completely crazy spiral. The agencies are just grossly profiteering out of it." Read full story Source: The Guardian, 14 November 2021
  4. News Article
    Trusts in more than half English local authorities still do not have an agreed safe place to discharge recovering covid patients to, despite the government asking councils to identify at least one such ‘designated setting’ by the end of October. The situation is leading to an increase in delayed discharges from hospital just as the service comes under increased pressure from the second covid wave and returning elective and emergency demand. In a letter last month, the government told local authorities to identify at least one “designated setting” – typically a care home – which hospitals could discharge covid positive patients to when they no longer need secondary care. The designated setting would also take discharged patients who had not received a negative covid test. The plan is designed to protect residents in other homes, after thousands of care home residents died due to outbreaks of the virus in the spring. But a well-placed source in the care sector told HSJ less than half of the 151 upper tier councils met the 31 October deadline, due to a range of reasons including insurance costs, fear of high mortality rates and reputational damage to the designated homes. It means that in many parts of the country, there are a lack of options when it comes to discharging patients, which is causing a rise in delayed discharges. Read full story (paywalled) Source: HSJ, 5 November 2020
  5. News Article
    Delays in discharging patients from hospitals is making pressure on the NHS from the second wave of coronavirus worse, hospital chiefs have warned. Some hospitals are already reporting almost all of their beds are full with patients as the number of coronavirus cases continues to surge with more patients needing hospital care every day. Doctors have told The Independent the lack of discharges means fewer beds are free and some hospitals are seeing long waits in A&E for beds to become available. NHS Providers chief executive Chris Hopson said: “Some of our chief executives are saying they are seeing bed occupancy levels of 92, 93, 94 per cent at the end of October when they would normally expect these to be 86, 87, 88 per cent. “Given where we are in terms of the winter cycle, and the fact we are not really at the beginning of winter yet, that is a worry." “There are much higher bed occupancy levels now than you would normally expect to see at this time of the year.” Without enough spare beds, hospitals will not be able to go ahead with planned surgeries and will have to make patients wait longer for a bed in accident and emergency departments. Read full story Source: The Independent, 30 October 2020
  6. News Article
    The government has been warned it is throwing “a lit match into a haystack” by discharging Covid-positive patients to care homes, with politicians demanding that the safety of residents and staff is guaranteed under the new policy. During the first wave of the pandemic, approximately 25,000 hospital patients were sent to care homes – many of whom were not tested – which helped spread the virus among residents. Around 16,000 care home deaths have been linked to COVID-19 since the start of the crisis. The strategy was one of the government’s “biggest and most devastating mistakes” of the crisis, says Amnesty International, and questions have been raised over the decision to introduce a similar policy as the UK’s second wave intensifies. As part of the 2020 adult social care winter plan, the government has called on local authorities and care providers to establish “stand-alone units” – so-called “hot homes” – that would be able to receive and treat Covid hospital patients while they recover from the disease. There is also an expectation that, due to housing pressures and a shortage of suitable facilities, some patients may be discharged to “zoned accommodation” within a home, before being allowed to return to normal living settings once they test negative for the virus. Councils have been told to start identifying and notifying the Care Quality Commission of appropriate accommodation, and to ensure high infection prevention standards are met. Under the requirements outlined by the government, discharged patients “must have a reported Covid test result". However, The Independent revealed on Monday that these rules have not been followed in some cases, with a recent British Red Cross survey finding that 26 per cent of respondents had not been tested before being discharged to a care home. There is also concern whether care homes possess enough adequate personal protective equipment to prevent outbreaks, with the CQC revealing last month that PPE was still not being worn in some sites. Read full story Source: The Independent, 27 0ctober 2020
  7. News Article
    Almost half of hospital patients have been discharged without receiving the results of their coronavirus test – including some patients who were sent to care homes, new research from Healthwatch and British Cross has revealed. Independent national patient body Healthwatch England said it had learned many patients were discharged from hospitals between March and August this year without proper assessments with many vulnerable people sent home without medication, equipment or the care they needed. At the start of the pandemic thousands of patients were discharged to care homes as NHS England instructed hospitals to free up 15,000 beds ahead of the first wave of coronavirus. Approximately 25,000 patients were sent to care homes with some not tested, sparking fears this helped seed care homes with the virus. There have been around 16,000 care home deaths linked to COVID-19. According to a survey of almost 600 discharged patients and interviews with 60 NHS staff, Healthwatch England said it had found serious flaws with the way hospitals had followed NHS England’s instructions. Read full story Source: The Independent, 24 October 2020
  8. News Article
    Serious patient safety and wellbeing concerns about the latest hospital discharge guidance have been raised to HSJ by senior clinicians and charities. Senior geriatricians warned that the guidance could prompt an increase in “urgent readmissions”, “permanent disability” and “excess mortality”, while charities said families could be left with “unsustainable caring responsibilities” because of the new rules. The government guidance, Hospital Discharge Service: policy and operating model, published in August, said clinicians should consider discharging patients when they were “medically optimised” rather than “medically fit”. It said 95% of these patients would return straight home with additional social care and rehabilitation support if needed. Many of the concerns raised surround the retention of the “criteria to reside”. This was originally agreed in March when there was a push from NHS England to free up acute beds over fears hospitals would become overwhelmed with covid admissions as the pandemic hit the UK. The criteria has, however, been maintained in the new guidance, despite a significant fall in infections and deaths from the virus. Rachel Power, chief executive of The Patients Association charity, warned: “This guidance makes it clear that the NHS is still having to take drastic emergency action in the face of covid-19, that will continue to take a heavy toll on patients. It is clear that many patients will be rushed home who would normally have had a longer period of hospital care.” Read full story (paywalled) Source: HSJ, 8 September 2020
  9. News Article
    Government plans to cut off funding for hospital discharge at the end of March will slow down the NHS recovery of planned care, and threatens ‘distress’ for families asked to quickly take over patients’ care. Since the pandemic began the Department of Health and Social Care has funded measures to smooth discharge from hospital, to help free up capacity. From September last year this was via a £588m national pot for up to six weeks’ funded care and support after discharge. But a letter from NHS England director of community health Matthew Winn last week confirmed the funding will cease at the end of March, with local NHS organisations or councils liable for the continued funding of discharge packages in the 2021-22 financial year. Jennifer Burns, president of the British Geriatrics Society (BGS), which has previously written to the government to urge an extension of the scheme, told HSJ: “The BGS is incredibly concerned… The disappearance of funding for care in the six-week period after discharge creates a cliff edge in the very near future. We urge the government to reconsider this decision and commit to recurrent discharge funding in the upcoming Budget.” Miriam Deakin, NHS Providers director of policy and strategy, said the government’s funding had “played a crucial role in freeing up hospital beds [and] managing capacity”, despite the delays caused by other parts of the system during the coronavirus winter surge. Ms Deakin warned: “Trust leaders are keen to see this funding continue in the longer term. This new way of working does not come without a financial cost, particularly for community services and their staff who are now much more thinly stretched, supporting patients with a wider range of more complex needs at home and in other community settings. We would therefore urge government to continue discharge to assess funding from April 2021.” Read full story (paywalled) Source: HSJ, 18 February 2021
  10. Event
    Unsafe medication practices and medication errors are a leading cause of injury and avoidable harm in health care systems across the world. WHO Patient Safety Flagship has initiated a series of monthly webinars on the topic of “WHO Global Patient Safety Challenge: Medication Without Harm”,. The main objective of the webinar series is support implementation of this WHO Global Patient Safety Challenge: Medication Without Harm at the country level. Considering the huge burden of medication-related harm, Medication Safety has also been selected as the theme for World Patient Safety Day 2022. With each transition of care (as patients move between health providers and settings), patients are vulnerable to changes, including changes in their healthcare team, health status, and medications. Discrepancies and miscommunication are common and lead to serious medication errors, especially during hospital admission and discharge. Countries and organizations need to optimise patient safety as patients navigate the healthcare system by setting long-term leadership commitment, defining goals to improve medication safety at transition points of care, developing a strategic plan with short- and long-term objectives, and establishing structures to ensure goals are achieved. At this webinar, you will be introduced to the WHO technical report on “Medication Safety in Transitions of Care,” including the key strategies for improving medication safety during transitions of care. Register
  11. Content Article
    The Quality Network for Inpatient Working Age Mental Health Services (QNWA) based within the Royal College of Psychiatrists' Centre for Quality Improvement are pleased to announce the publication of their 8th edition standards. Since the publication of the first edition standards in 2006, the Network has grown to include over 140 members from the NHS and private sector. This new edition of standards aims to reflect the changes in working practices and legislation over the last two years in addition to placing greater emphasis on equality, diversity and inclusion as well as sustainability in inpatient mental health services. The eighth edition standards have been drawn from key documents and expert consensus and have been subject to extensive consultation with professional groups involved in the provision of inpatient mental health services, and with people and carers who have used services in the past.
  12. Content Article
    Medicines reconciliation is the process of accurately listing a person’s medicines. This could be when they're admitted into a service or when their treatment changes.
  13. Content Article
    This Healthcare Safety Investigation Branch (HSIB) investigation explores issues around patient handover to emergency care. Patients who wait in ambulances at an emergency department are at potential risk of coming to harm due to deterioration or not being able to access timely and appropriate treatment. HSIB has published an interim report outlining early investigation findings, and recommends a national response to tackle this urgent issue. Findings so far emphasise that an effective response should consider the interactions of the whole system: an end-to-end approach that does not just focus on one area of healthcare and prioritises patient safety. For its reference case, the investigation looks at the case of a patient who was found unconscious at home and taken to hospital by ambulance. The patient was then held in the ambulance at the emergency department for 3 hours and 20 minutes, and during this wait their condition did not improve. They were taken directly to the intensive care unit where they remained for nine days before being transferred to a specialist centre for further treatment.
  14. Content Article
    Every year, thousands of emergency department (ED) visits result in patients being discharged with oral antibiotic prescriptions. Published studies that assess the appropriateness of these antibiotic regimens are limited. The purpose of this study from Bauman et al. was to examine the appropriateness of antibiotic prescriptions written for patients discharged from a community hospital’s ED. A total of 76% of the prescribed antibiotics were appropriate, 16% were inappropriate, and the remaining 8% were not assessable. Duration was the most common reason for a regimen to not be optimal. The most frequently inappropriately prescribed antibiotics included cephalexin (but it is noted cephalexin was included in almost half of the antibiotic regimens in this study), clindamycin, and azithromycin. Infections that were most frequently treated inappropriately were skin and soft tissue infections, dental infections, and sinusitis. 
  15. Content Article
    This article published by The Conversation looks at the pressures faced by ambulance services and emergency departments across Australia as a result of Covid-19. There has been an increase in 'ramping', where ambulances queue up outside hospitals. Ramping is a sign that the whole health system is under immense pressure. The article looks at the large amounts of funding Australian local governments are putting into ambulance services and emergency departments (EDs), but highlight that this will not solve the issues face by the health system if issues discharging patients into community and social care remain. It highlights a model developed in Leeds, UK, that has been adopted by the health service in Victoria, Australia, focused on solving more systemic issues. The Leeds model aims to improve patient flow in and out of the hospital and ensure that patients are quickly transferred from ambulances into EDs. Discharge coordinators organise the care patients need in the community after an ED or hospital stay. The authors also look at the role of community paramedics in keeping patients out of hospital and their potential to reduce financial and capacity pressure on health systems worldwide.
  16. Content Article
    The NHS and social care systems need more money. If there is anything else that they need as much, it is honesty from the government. Post-Covid, the UK’s health systems are in a perilously fragile state. As analysis by the Guardian showed this week, logjams created by delayed discharges appear to be getting worse. An average of 13,600 hospital beds in England are occupied by patients with nowhere else to go. As well as making new admissions impossible, unnecessarily long stays can make it harder for people to regain their independence after leaving. So far, a £500m emergency fund promised by ministers to ease the pressure has failed to materialise. It is a symptom of the social care crisis that hospitals find it so hard to discharge people who are well enough to leave.
  17. Content Article
    This National Institute for Health and Care Excellence (NICE) guideline covers the components of a good experience of service use. It aims to make sure that all adults using NHS mental health services have the best possible experience of care. It includes recommendations on: access to care assessment community care assessment and referral in crisis hospital care discharge and transfer of care assessment and treatment under the Mental Health Act
  18. Content Article
    When leaving hospital with medicines, there can be a lot of information to take in. This checklist designed by the Royal College of Physicians (RCP) Quality Improvement and Patient Safety (QIPS) is designed to help patients and their carers use medications safely when they leave hospital. It includes: Questions to consider before you leave hospital Questions to consider when you’ve left hospital Further useful resources Medicines safety and governance pharmacist Jen Flatman has written a blog about how the checklist was developed.
  19. Content Article
    In this blog, Jen Flatman, medicines safety and governance pharmacist, discusses a resource to support people to continue to use their medicines safely once they leave hospital. The medicines safety checklist was designed by patients and carers, for patients and carers, helping bridge the transition between hospital and the next destination. The points on the checklist are designed to act as a prompt, ensuring individuals are aware of key information to continue to use their medicines safely. They also act as a reminder to the reader to ask questions if they are unsure about anything.
  20. Content Article
    Transitions of care between hospital departments are necessary, but they may disrupt care coordination, such as discharge planning. Family carers often serve as liaisons between the patient and healthcare professionals, but they frequently experience exclusion from care planning during intrahospital transfers (IHTs). This has the potential to decrease their awareness of patients’ clinical status, postdischarge needs and carer preparation. This study aimed to explore family carers’ perceptions about IHTs, patient and carer ratings of patient discharge readiness and carer self-perception of preparation to engage in at home care.
  21. Content Article
    This Nuffield Trust Quality Watch blog from Sophie Flinders and Sarah Scobie takes a closer look at the rising number of patients facing delays in leaving hospital – and explores the reasons for why it’s happening.
  22. Content Article
    The Patient Safety Authority has put together information and tips for patients on a range of topics.
  23. Content Article
    This comprehensive guide from the Social Care Institute of Excellence, discusses the lessons learned from hospital discharge and avoidance during the COVID-19 pandemic. It highlights challenges faced and good practice to prevent unnecessary admissions going forward.
  24. Content Article
    On 23 September, Improvement Cymru, the all-Wales Improvement service for NHS Wales, hosted an online session with colleagues from Holland to talk about patient flow in hospital. 
  25. Content Article
    A new report from Healthwatch and the British Red Cross looks at how well the new hospital discharge policy is working for patients, carers and healthcare professionals. In March 2020, the Government introduced a new hospital discharge policy to help the NHS free up beds by getting people out of hospital quickly. This meant anyone who may need out-of-hospital support to help them recover would now have their needs assessed after being discharged, rather than in hospital.  How has the new policy affected people's experience of leaving hospital? Healthwatch and the British Red Cross spoke to over 500 patients and carers and conducted 47 in-depth interviews with health and care professionals involved in the hospital discharge process.  The research shows significant numbers of people are not receiving follow-up support after being discharged from hospital under new policy, leading to unmet needs. 
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