Hospital discharge and preventing unnecessary hospital admissions (COVID-19)

Hospital discharge and preventing unnecessary hospital admissions (COVID-19)
SCIE August 2020

• This guide 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.

ActNow e-learning tool

ActNow e-learning tool
NHS England/Improvement 4 November 2019

• The ActNow elearning tool has been developed for health service and care staff to help them reduce hospital delays for patients. It covers the use of new technology, effective early discharge planning and caring for people at home.

Housing to Health Nottingham

Housing to Health
Nottinghamshire City Homes, Nottingham CCG 2019

• Housing to Health is a partnership between Nottingham City Homes and Nottingham City Care Partnerships aimed at helping to ease the strain on the health service by providing suitable homes to speed up a patients discharge from hospital, or directing people at risk of being admitted to hospital due to their poor living conditions into good quality homes. 
• An evaluation report shows the impact of the project for the period November 2015 to March 2018.

Home to the unknown: Getting hospital discharge right

Home to the unknown: Getting hospital discharge right
Red Cross 2019

• Research about patients’ experience of discharge from hospital and their transition from hospital to home reveal that, despite a wealth of guidance on ‘ideal’ hospital discharge and examples of excellence and good practice, problems persist. 
• Discharge processes vary considerably, not just between nations but within even local areas.

The long-stays dashboard

The long-stays dashboard
NHS Improvement 9 July 2018

• NHS Improvement have developed a dashboard to help providers, CCGs and local authorities to monitor and manage hospital length of stay in acute hospitals.
• Requires registration with the National A&E dashboard.

Delayed transfers of care in the NHS

Delayed transfers of care in the NHS
House of Commons Briefing Paper 20 June 2017

• A briefing paper looking at policy and statistical trends on delayed transfers of care (DTOC) in the NHS including recent trends, costs, the causes, approaches to reducing DTOC (including Better Care Fund) and regional variations.

Acting without delay - How the independent sector is working with the NHS to reduce delayed discharge

Acting without delay - How the independent sector is working with the NHS to reduce delayed discharge
NHS Partners Network, NHS Confederation 14 June 2017

• A series of case studies which demonstrate how strong partnerships between the NHS and independent sector providers are tackling the issue of Delayed discharges and transfers of care (DTOCs).
• Includes: virtual wards, complex care provided in care homes, use of spare capacity in independent hospitals, better use of intermediate care, specialist rehabilitation to improve patient recovery.

Delayed discharges and hospital type: evidence from the English NHS

Delayed discharges and hospital type: evidence from the English NHS
CHE Research paper 133, Centre Health Economics, University of York, July 2016

• Analysis of delayed discharges across different hospital types in England indicates that greater local supply of long-term care (care home beds) is associated with fewer delays. 
• Hospitals which 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.

Discharging older patients from hospital

Discharging older patients from hospital
National Audit Office 26 May 2016

• This report examines how effectively the health and social care system is managing the discharge of older patients from hospital, in particular: 
• the scale of delays that older patients experience in hospital (Part One);
• the extent to which health and social care providers are adopting good practice in discharging older patients (Part Two): and
• barriers to local health and social care systems working effectively (Part Three).
• Includes local data tables for Delayed discharges, A&E admission LOC and Adult social care spend

Investigations into unsafe discharge from hospital

A report of investigations into unsafe discharge from hospital
Parliamentary and Health Service Ombudsman 11 May 2016

• This report focuses on nine experiences drawn from recent complaints which illustrate the problems with regards to unsafe discharge from hospital. The most serious issues identified are:
• Issue one: Patients being discharged before they are clinically ready to leave hospital
• Issue two: Patients not being assessed or consulted properly before their discharge
• Issue three: Relatives and carers not being told that their loved one has been discharged
• Issue four: Patients being discharged with no home-care plan in place or being kept in hospital due to poor co-ordination across services
• The report highlights three key areas that warrant particular attention:
• Failures to check people's mental capacity and offer legal protections for those who lack capacity
• Carers and relatives not being treated as partners in discharge planning
• Poor co-ordination within and between services

Older people in acute settings - benchmarking report

Older People in acute settings Benchmarking report 2014
NHS Benchmarking Network April 2015

• Report of the first phase of a national benchmarking project looking at older people in acute settings involving 47 trusts and health boards.
• Findings of the project across the four areas of the pathway : admission avoidance in A&E, assessment units, inpatient care and supported discharge.  Within each area of the pathway the service models, activity, workforce and finance data is explored.

Extracts relating to service models:

• A&E
• 24% of participating Trusts / LHBs have a dedicated geriatric team located in the A&E department. 85% report therapists are available in A&E to assist with admission avoidance of older people. 62% of organisations have rapid access to social workers in A&E, and 44% report that in-reach is provided by the Hospital Discharge Team. 
• Assessment units 
• 30% of Trusts/LHBs have a frailty unit, with 42% using a recognised frailty tool within the frailty unit. 90% of frailty units use Comprehensive Geriatric Assessment, and 77% have a dedicated geriatric team located in the frailty unit. 
• Inpatient care 
• The average number of elderly care beds per Trust / LHB is 106 beds. Comprehensive Geriatric Assessment is delivered on 87% of elderly care wards, and 23% of other speciality wards. All inpatient wards have regular ward and board rounds. A social worker or supported discharge co-ordinator forms part of the MDT on elderly care wards in 86% of Trusts / LHBs. 
• Discharge process 
• There is a documented supported discharge protocol consistently applied across all wards in 87% of Trusts / LHBs. 23% of organisations have an integrated discharge team and, where supported discharges do not go through the IDT, they are dealt with directly by ward staff. All organisations reported that inpatient wards have dedicated ward discharge co-ordinators. 85% of Trusts / LHBs operate Early Supported Discharge schemes, with 37% having access to dedicated Pharmacy advice for supported discharges. The average length of time for a continuing healthcare assessment to take place is 12 days.