The risks from failing to get hospital discharges right

Hospital discharge remains a hot topic for all of us who work with older people.

As the recent National Audit Office (NAO) 2016 report on discharging older patients from hospital rather bluntly put it: ‘There are currently far too many older people in hospitals who do not need to be there.’

Hospital clearly is not the right place for older people once acute health problems have been addressed. Long hospital stays lead to risks including loss of mobility and function and hospital-acquired infection.

Unnecessary delays

Yet despite growing recognition of the need for improved discharge planning and communication between care providers, and recent highlighting of the problems by the Care Quality Commission 2016 building bridges report, over the last two years there has been a 31% increase in days in acute hospitals when beds have been occupied by patients who have had their discharge delayed unnecessarily.

Plan of action

The effect of delayed discharge is particularly felt by people with dementia. They often have complex needs, and can be exposed to high risks if they are in hospital for longer than they need to be. They need well co-ordinated person-centred discharge planning that identifies their ability to make decisions and supports them to participate in planning as far as possible.

Planning can begin with a mental capacity assessment. Aileen Murray explores aspects of the Mental Capacity Act and clinical practice that affect older patients’ outcomes on discharge from hospital. Her case study provides a vivid example of the importance of assessment, even for a person with mild dementia.

Effective multidisciplinary working, proper application of legal frameworks and risk assessment are vital.

Need for assessments

However, the main reason for delayed discharge is still because older people are waiting for a package of home care or care home placement, with nursing home places for people with dementia often under the greatest pressure. Hospital practitioners have a vital role in carrying out robust assessment and care management but there are still many barriers to effective discharge.

The NAO report recommends that the Department of Health, NHS England and NHS Improvement should set out how they will break the trend of rising delays against the demographic challenge of growing numbers of older people.

References

Care Quality Commission (2016) Building Bridges, Breaking Barriers report

National Audit Office (2016) Discharging Older Patients from Hospital report

Nicky Hayes is consultant editor, Nursing Older People, and nurse consultant for older people, King's College Hospital NHS Foundation Trust