Healthwatch Essex study looks at hospital discharge stats

Health / Wed 14th Dec 2016 at 04:32pm

HEALTHWATCH Essex has published their most significant report to date following an innovative research study that looked at hospital discharge processes first hand, involving almost 200 hours of observation and over 200 interviews with patients, staff, and family carers.

Healthwatch Essex Chief Executive, Dr Tom Nutt, said, “We took two years to conduct this study and draw together all of our findings across three hospitals for this major new research report that really gets to the heart of the issues around discharging patients from hospital.

“Again and again we have heard various sources discuss the issue of hospital discharge, but until now – at least in Essex – the full catalogue of problems have not been laid bare for all to see in such a comprehensive way.”

Data was triangulated from research techniques carried out at Colchester General, Princess Alexandra and Broomfield Hospitals by Healthwatch Essex’s Research Team as part of a hugely ambitious study. Former Commissioning and Research Manager at Healthwatch Essex – now Senior Research Fellow at Anglia Ruskin University – Dr Oonagh Corrigan, led the work.

“We’re very grateful to all three hospitals for giving us such unprecedented access to patients and staff and we have been pleased by their reaction to the report and its findings,” said Dr Corrigan.

“I think everyone recognises that when the discharge process doesn’t work very well, everyone loses. The hospitals suffer from so called ‘bed blocking’, patients are put through unnecessary stress, and family carers find themselves having to pick up the pieces around ongoing support from social care and the like.”

The key findings revealed that in all too many cases both patients and family carers were not involved in the planning of discharge and follow-up support, which contributed to a lack of continuity of care and sometimes saw patients readmitted.

Being discharged too soon was another key finding. Some patients – particularly some elderly patients and those who had care responsibilities or little family or other support – reported feeling under pressure to leave hospital before feeling ready to be discharged.

Delays on the day of discharge were also commonplace due to hold-ups in the delivery of take-home medication, hospital transportation and information such as letters for GPs and discharge or care plans.

Where assessments for care packages were required, delays could be exacerbated by a lack of coordination between health and social care and the shortage of care places in the community, care homes, nursing homes and re-ablement services.

One of the core issues that impacted the discharge process again and again was poor communication. Often the problem was about poor internal methods of communication, leading to staff frequently not having the right information regarding a patient’s readiness and needs for discharge.

From the patients’ perspective, it was noted that they were often told different things by different members of staff regarding the timing of their discharge, which led to further delays, confusion and frustration for them and their family care givers.

The 88-page report not only sets out a comprehensive picture of the state of hospital discharge processes across the three hospitals, but draws together common themes. It also outlines a series of recommendations for addressing the main issues faced by the hospitals.

The four principal recommendations are:

1. The provision of information and communication systems

All hospitals should instigate systems to improve communication with patients and their families, which will involve them in discharge planning. Communication between staff within the hospital, and with other organisations (most notably social care), should be improved by the introduction of rigorous systems to gather, store, retain and share information.

2. Training

All frontline hospital staff, and in particular staff working in wards with a high turnover of older patients, should receive mandatory training in hospital discharge planning. CCGs, medical schools and training organisations should work together and incorporate discharge related care planning within the curriculum of all trainee health professionals.

3. Integration and continuity of care

Local health and social care commissioners should find ways to bring the health and social care sectors under a unifying vision of care, developing new integrated care pathways to make care safer and more patient-centred. This should be part of the ongoing work being carried out by the STPs (Sustainability and Transformation Plans) to integrate services.

4. Raising awareness and planning ahead

Health and social care services should work together to find new ways of informing the public about the care services offered in their locality, and how and when to access them. It may be that the increasing pressure on acute hospitals is the result of a struggling primary and community care sector.

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