According to NHS England, nearly 350,000 patients spend more than three weeks in a hospital each year.
Delays in hospital discharge can be detrimental
Some patients need to be there for medical reasons, but many remain in hospital unnecessarily when they’re well enough to go home but can’t do so without extra support.
These delays are not only distressing for patients and their families, they can be detrimental to patients’ health, reducing their chances of returning to an independent life. For example, many older people, who may be frail or have dementia - and mental health patients - actually deteriorate whilst in hospital. Research by NHS England has identified that a stay of more than 10 days for elderly people leads to the equivalent of 10 years of muscle ageing for those most at risk.
Shorter hospital stays benefit patients - they make better recoveries in their own homes and in their local communities.
Criteria-led discharge tracker computer system reduces discharge delays
Bradford District Care NHS Foundation Trust has made significant progress over the last year in reducing long hospital stays for people who are well enough to leave. We’re working with our wider community services including medical staff, clinicians, voluntary sector teams, and local authority colleagues to design the system.
A criteria-led discharge tracker is a computerised system that allows ward teams to identify and tackle any barriers that are preventing people from being discharged when they’re first admitted to hospital. Since the new system was introduced, dialogue with health and social care support is better coordinated when people leave so they can regain their independence in the community.
The system identifies if and when a patient has a planned discharge date and whether they are clinically ready for discharge. This helps staff to create a robust discharge plan, ensuring that all health and social care support is in place ready for reentry into the community.
For many people in experiencing crisis, housing issues such as being homeless, family breakdown, or debt can be a cause of delayed discharge from hospital. The criteria-led discharge tracker and multiple agency conversations flags issues on admission, so we can start working with the council, housing specialists, benefits team, and social worker on day one to improve easy access to housing for these vulnerable people.
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We provide an intensive home treatment service which operates seven days a week, meaning that more people than the national average leave hospital at weekends; we’ve also seen a reduction in the number of re-admissions.
We assign a care coordinator to make sure people are looked after in the community appropriately when discharged. This support can include things like physiotherapy from a healthcare assistant or help from an occupational therapist to support loneliness. An occupational therapist can help someone build confidence in doing everyday things like going to the shops, or to give assistance filling out forms for housing. If a person needs someone to look after them when they come out of hospital, we ensure this is in place when they go home.
This integrated approach has been shared with the wider West Yorkshire and Harrogate Integrated Care System. We’ve seen a 50% reduction in the length of time our patients spend on wards. Our Length of Stay (LoS) performance and our delayed transfers of care (DTOC) has a rate of 1.9 days delayed per 100,000 compared to the England average of 10.3 days. This has enabled us to support people’s recovery at home and free up more beds for patients who are in crisis.
Using the criteria-led discharge tracker ensures that patients receive the right care, in the right place, including community-based support, delivered by the right health or social care professional to support their recovery and ongoing wellbeing.
Grainne Eloi is the Interim Head of Mental Health Services at Bradford District Care NHS Foundation Trust.