launched today by health minister Rosie Winterton, focuses on
practical steps that health and social care professionals can take to
eliminate delays in discharging patients from hospital.
Staff often have to spend too much valuable time managing mismatches
between when beds are needed for patients being admitted and when
they are made available by other patients being discharged. This is
despite the fact that at least 80% of discharges can be classified as
'simple', meaning that the patients have relatively simple ongoing
health needs that can be met without complex planning.
In some cases this can mean that patients who are well enough to go
home stay in hospital while patients who need to be admitted wait
longer than necessary in A&E for a bed to become free.
The new toolkit includes a 10 step guide to improving discharge
processes, case studies showing how real improvements have already
been delivered, and useful factsheets helping staff to identify what
action they need to take. It aims to empower all the members of the
multi-disciplinary teams involved in planning and arranging the
smooth discharge of patients from hospital by supporting them in new
ways of working.
Health minister Rosie Winterton said: 'This new toolkit is another
step on the way to transforming emergency care for patients. We know
from the Healthcare Commission's national surveys that patients
recognise delays in being allowed home as an area where standards
need improvement. We also know that smoothing the flow of patients
through the whole system is essential if we are to continue the
progress towards meeting the four-hour A&E total time target.
'I hope staff find the toolkit genuinely useful. It will help them to
deliver the key actions like treatment plans and expected dates of
discharge for all patients within 24 hours of arrival in hospital.
And the case studies clearly demonstrate the benefits of involving
the patients themselves in the discharge process.
'Patients don't want to hang around in hospital unnecessarily when
they are well enough to leave. Improving the way that discharges are
managed will have a big impact on their experience of the NHS, as
well as on the working lives of front line staff.
Director for patients and the public, Harry Cayton, said: 'No-one
wants to spend more time in hospital than they have to. But leaving
hospital if you have been seriously ill or are frail can be a
worrying time. Making the right arrangements with social care and
with friends and family is essential. I hope this guide will help the
NHS to get it right for everyone.'
1. The 'Achieving timely 'simple' discharge from hospital' toolkit is
2. The NHS Plan target for total time in A&E is that by the end of
2004 all A&E patients should be discharged, admitted or transferred
within four hours of arrival. To allow for clinical exceptions to the
target (i.e. patients who for clinical reasons need to remain in A&E
longer than four hours) trusts will be expected to reach an
operational standard against the target of 98%. Current performance
is approximately 95%.
3. 'Timely' discharge is when the patient is discharged home or
transferred to an appropriate level of care as soon as they are
clinically stable and fit for discharge.
4. 'Simple' discharge patients will normally go to their own home and
can be discharged directly from A&E, ward areas or assessment units.
'Complex' discharge will often be to a carer's home, intermediate
care or a care home; these patients' lengths of stay are harder to
predict and they will have complex ongoing health and social care