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Discharging older patients: how a single form could help avoid unnecessary hospital delays

Important information about an older person can be hard to access or record, but a new form could benefit healthcare staff, patients and families

Important information about an older person can be hard to access or record, but a new form could benefit healthcare staff, patients and families

When I was a practising nurse I saw first hand the consequences of delays in discharging older patients when they no longer needed hospital care.

Aside from the obvious financial burden on our health services, staying in hospital too long can lead to functional decline, increased confusion and a loss of confidence for many older people.

Now, as a health services researcher, I want to find out why these delays happen and what can be done to help.

Hard to decide what level of normal is acceptable for

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Important information about an older person can be hard to access or record, but a new form could benefit healthcare staff, patients and families

A still from the Information About Me campaign video
A still from the Information About Me campaign video

When I was a practising nurse I saw first hand the consequences of delays in discharging older patients when they no longer needed hospital care.

Aside from the obvious financial burden on our health services, staying in hospital too long can lead to functional decline, increased confusion and a loss of confidence for many older people.

Now, as a health services researcher, I want to find out why these delays happen and what can be done to help.

Hard to decide what level of ‘normal’ is acceptable for older people living with frailty to be discharged

Older people living with frailty are the group most likely to be delayed in hospital, particularly when they are admitted as an emergency. Because they often present with multimorbidities, polypharmacy, cognitive impairment and disability, it is more challenging to decide what level of ‘normal’ is acceptable for them to be discharged.

A patient with an Information About Me form
A patient with Information About Me form. Picture: Tim George

Our team – experienced in research into the care of older people – tracked 37 older patients living with frailty from admission to discharge in two teaching hospitals, Bristol’s Southmead Hospital and Birmingham’s Queen Elizabeth Hospital, and their local community and social care services.

This data was collected between September 2018 and March 2019. We interviewed patients, carers, nursing and medical staff about what they thought made the discharge process easier or harder.

What we found was that when patients were admitted they were ‘deconstructed’ into fragments of information. Delays happened when this information was being put back together, including the ‘collateral history’ that is so important when planning for a patient to be discharged.

Patients and relatives felt staff were not communicating effectively

Although staff asked about the patients’ home circumstances, level of functioning and care provision, we found this information was either inadequately recorded, difficult to find or not recorded at all.

The same information was often recorded by different people, in different formats and with different emphases.

This frustrated and concerned patients and relatives, as it made them feel that staff were not communicating effectively and led to them losing confidence in care arrangements.

But when the recording of this information was done well, was readily available and staff used it, we found it was appreciated by patients and relatives, and it resulted in quicker discharges.

Our findings gave us an idea: to design a single form that patients, relatives or carers could use to record important information, either before attending or on arrival at hospital. It is called Information About Me.

One form and five ways to improve care of older people in hospital

  1. Consider using one form, such as the Information About Me form, to collect information from patients and relatives on admission about a patient’s home circumstances, level of functioning and care provision
  2. Ensure that all staff can access this information easily, and think about how you would hold this information and which platform would work best for your hospital
  3. Use this document as a basis for conversations with patients, relatives and carers
  4. Include this information in all multidisciplinary team conversations about the patient, alongside other important information regarding clinical care, so it is seen as having equal value in terms of early discharge planning
  5. Think about hospital care no longer being required earlier in the patient’s stay, even if what is ‘normal’ for the patient may be considered suboptimal

Hospitals, patients and public contributors helped with Information About Me form

We worked with the hospitals in the study to ensure the form covers the information they need, and with patients and public contributors to make sure it is accessible and clear.

One woman recounted her experience of the delayed discharge of her mother, aged 93, and how the form could have helped the medical staff understand when it was appropriate to treat her mother and when it was not.

She felt the consultant was not acknowledging her mother’s ‘normal’ and that no amount of intervention was going to change that, so she would be better being discharged home to a place where she felt happy and safe: ‘Ten days went by. She was pretty confused by this point. I was then told that her blood test results weren’t normal, so the consultant wanted her to stay a bit longer. I didn’t think it was appropriate to intervene for something that she hadn’t been admitted for. Staff need to understand what the person’s baseline was before they went into hospital. With my mother, I never had the chance to set this out – no one seemed to be listening.’

To highlight the importance of Information About Me to patients, carers and staff, we made an animation that outlines the issues and points viewers to the form.


Watch: Helping staff with an older person's hospital stay


By encouraging patients and carers to record this information themselves and understand its value, we aim to reduce the time staff take collecting it, but also to increase their appreciation of Information About Me when discharging older patients.

COVID-19 makes it more important that people are not in hospital for longer than they should be

Now we are working with local healthcare providers to explore how the form can be accessed and shared.

COVID-19 means there is now an even greater urgency to making sure people are not in hospital for longer than they need to be.

Hopefully the Information About Me campaign will empower patients and families to take responsibility for providing the information that could make a big difference, as well as promoting its importance to nursing and medical staff.

View the RCNi frailty resource collection


Find out more

Download a sample Information About Me form

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