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Hospitals will struggle to reach new 12pm discharge goal

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Trusts have been told to try to carry out at least 35% of discharges before midday, in a new NHS England directive aimed at preventing delayed discharges.

  • Trusts told to aim to discharge 35% of patients before midday
  • HSJ research shows that trusts only discharged 17.6% before 12pm on average throughout 2014-15
  • Increasing morning discharges will be a struggle, says trust chief executive

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However, an investigation by HSJ reveals that trusts have been falling far short of this “best practice” recommendation for improving urgent care, suggesting it will be difficult for trusts to boost their pre-midday patient discharge rates.

Among the 88 acute trusts across the country that responded to a freedom of information request by HSJ, the average discharge rate before midday was 17.6% in 2014-15.

Last month NHS England developed eight “high impact interventions” that it expects system resilience groups to adopt. These included:

  • 35 % of discharges to be carried out before midday;
  • senior clinicians leading a daily review of inpatients seven days a week, so that hospital discharges at the weekend are at least 60 per cent of the weekday rate; and
  • reducing the delayed transfer of care rate to 2.5 per cent.

The research showed that Chelsea and Westminster Hospital Foundation Trust had the highest discharge rate before 12pm in 2014-15 at 26.2%. Meanwhile, Barts Health Trust had the lowest discharge rate at 10.4%.

A spokesman for Barts said pre-midday discharges were being prioritised but that the high numbers of patients requiring social care services or a nursing home “present a challenge”.

Rupert Wainwright, director of Zenon Consulting and until recently interim deputy chief operating officer at Sandwell and West Birmingham Hospitals Trust, said many trusts struggling to find beds would focus on discharging patients in the evening who would be most eligible for discharge before 12pm.

He said: “The oddity is that when in the evening you desperately need beds, the first patients you pick on are those that are ready to be discharged before 12pm, so you discharge them the evening before. Then you’ve run out of patients you can discharge before 12pm the following day.

“It’s really very rare to find a patient who can be discharged in the morning who you didn’t know was well enough the day before.”

He said that while it is “interesting and useful” to look at morning discharges, it is “missing a trick if the whole game here is to get patients home earlier so they aren’t hospitalised for too long”.

He added that the focus on morning discharges could cause “a whole load of hospitals” to “slow down slightly” because instead of being “desperate” to get the patients out the night before, “you win Brownie points by leaving them in an extra day”.

A trust chief executive told HSJ that it was difficult to discharge patients before midday because of logistical arrangements - drugs must be prescribed and dispensed, transport has to be arranged and social care or community equipment needs to be in place, they said.

The decision to discharge usually requires a doctor, who normally have morning commitments such as clinics or theatre lists, they added. This means discharge decisions are pushed into the afternoon.

However, improvements could be made to speed up the process, such as using discharge lounges, so a patient can leave a ward and free up a bed and have somewhere to wait while the discharge arrangements are made, the chief executive said.

An NHS England spokeswoman said: “These figures show that meeting the suggested standard for timely ward rounds would represent an important improvement in most hospitals, and all should now be reviewing their internal processes to do so.”

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