Transcript DELAYED DISCHARGE – AN NHS PERSPECTIVE

DELAYED DISCHARGE – AN
NHS PERSPECTIVE
RIETA VILAR
JOINT FUTURE PLANNING MANAGER
11 June 2007
WHAT IS A DELAYED DISCHARGE?

‘A DELAYED DISCHARGE IS EXPERIENCED BY AN INPATIENT
OCCUPYING A BED IN A HOSPITAL WHO IS CLINICALLY READY
TO MOVE ON TO THE NEXT STAGE OF CARE BUT IS PREVENTED
FROM DOING SO BY ONE OR MORE REASONS FOR DELAY IN
DISCHARGE’

READY FOR DISCHARGE DATE IS DETERMINED BY THE
CONSULTANT OR GP RESPONSIBLE FOR THE INPATIENT CARE
IN CONSULTATION WITH ALL AGENCIES INVOLVED IN PLANNING
THE PATIENT’S DISCHARGE BOTH NHS AND NON NHS.
A LITTLE BIT OF HISTORY:
 IN SCOTLAND AS MUCH AS 10% OF HOSPITAL BEDS
BLOCKED
 FIRST PUBLISHED CENSUS SEPTEMBER 2000
 OCT 2001 – WELL OVER 3000 PATIENTS DELAYED
 BY 2002 THIS WAS REDUCED TO BELOW 2000
 APRIL 2006 – 498 BEDS BLOCKED (OVER 6 WEEKS)
 APRIL 2007 – DOWN TO 233 (OVER 6 WEEKS)
IN GRAMPIAN:
 ALMOST 400 BEDS WERE BLOCKED (2001)
 NOW REDUCED TO JUST UNDER 100
 APRIL 2006 – 78 DELAYED DISCHARGES OVER 6 WEEKS
 APRIL 2007 – 33 DELAYED DISCHARGES OVER 6 WEEKS
TARGETS SET BY SCOTTISH
EXECUTIVE:
BY APRIL 2008 NO PATIENT WAITING LONGER THAN 6 WEEKS
IN HOSPITAL
AND
NO PATIENTS WAITING IN AN ACUTE BED (3 DAYS)
REASONS FOR THE 6 WEEKS:
 DISCHARGE IS COMPLICATED
 WILL TAKE TIME TO PUT SERVICES IN
 SAFE DISCHARGE
REASONS FOR DELAY:
 LACK OF VACANCIES IN CARE HOMES
 NO CAPACITY IN WOODEND OR COMMUNITY HOSPITAL
 LACK OF HOME CARERS TO SUPPORT PEOPLE
 LEGAL/FINANCIAL ISSUES
 FAMILY DISPUTES
TWO SPECIFIC GROUPS WHO ARE
LIKELY TO EXPERIENCE A DELAY:
 STROKE
 DEMENTIA
TWO SPECIFIC ISSUES WHICH
CONTRIBUTE TO LONG DELAYS:
 GUARDIANSHIP
 CHOICE
IMPORTANCE OF INVOLVING
USERS AND CARERS IN THE
DISCHARGE PROCESS
DELAYED DISCHARGES IS A
MAJOR ISSUE
 BEDS ARE REQUIRED FOR PEOPLE WITH MEDICAL NEEDS
 HOSPITAL IS NOT A GOOD PLACE FOR PEOPLE TO BE
ESPECIALLY TRUE FOR OLDER PEOPLE
 INSTITUTIONALISED VERY QUICKLY
 HOSPITAL ACQUIRED INFECTIONS
WHAT ARE WE CONCENTRATING
ON TO BRING DELAYED
DISCHARGES DOWN TO ZERO?
 PREVENTION OF ADMISSION
 DEVELOP MORE STEP UP/DOWN FACILITIES
 DISCHARGE PLANNING TO START ON ADMISSION (OR
EVEN BEFORE ADMISSION IF ELECTIVE)
RESEARCH QUESTION
 EFFECT ON PATIENTS/CARERS OF
IMPLEMENTING THE CHOICE POLICY