02.12.15
Hospitals told to appoint discharge coordinators to avoid delays
Hospitals should appoint a single health or social care practitioner responsible for discharging patients to avoid delays in discharge, according to new NICE guidance.
The health watchdog has recommended that the discharge coordinator role, which could be specially created or the responsibility handed to a member of the multi-disciplinary team looking after a particular person, should be the “central point of contact” for health and social care practitioners, the person and their family during discharge planning.
The guidance added that the coordinator should work with the hospital- and community-based teams to agree a discharge plan, which should take into account the person’s social and emotional wellbeing, as well as the practicalities of daily life.
Additionally, they should ensure that any specialist equipment and support is in place before the person is discharged from hospital, if it is required.
The latest social care guideline aims to ensure people with social care needs who need hospital treatment get the support they need to leave hospital in a co-ordinated and timely way.
This comes after recent NHS figures for August this year highlighted that more than 5,000 people experienced delays in their discharge from hospital, up from 3,961 in 2012.
Monitor also recently stated that the worst A&E performance in a decade against the four-hour emergency care standard last winter was driven, mainly, by hospitals struggling with very high bed occupancy rates.
The regulator added that hospitals also encountered more difficulties transferring patients awaiting discharge to other care providers. It was noted that delayed transfers of care increased by 27% in Q3 2014-15 compared to the same period the previous year. According to Monitor, this is “likely to have been the result of reductions in social and/or community care capacity”.
Professor Gillian Leng, deputy chief executive and director of health and social care for NICE, said: “Going into hospital can be an anxious time for many. For those with extra care needs, they may continue to worry about how they will cope when they go back home.
“Practitioners should be talking to each other, sharing information and planning discharge from the time the person is admitted or earlier if possible.
“We know that it can be challenging to co-ordinate a person’s discharge from hospital when they also have extra care needs. One of our recommendations is for a single person to co-ordinate the process for each individual to streamline and simplify the process.”
NICE says that the coordinator should be selected according to the person’s care and support needs, and that a named replacement should always cover their absence.
Furthermore, while planning for discharge, the discharge coordinator should share assessments and updates on the person’s health status, including medicines information, with both hospital and community-based teams.
Anna Bradley, chair of Healthwatch England, said: “Everyone should experience a safe, dignified and well planned transfer of care; however our special inquiry into unsafe discharge, ‘Safely Home’, found that sadly this is often not the case. We therefore welcome this new guidance from NICE.
“We heard shocking stories which highlighted how poor co-ordination of health and social care services and a failure to put patients at the heart of discharge planning is resulting in far too many people being kept in hospital longer than necessary, as well as many being discharged too early and being readmitted to hospital soon after. This comes at a huge human and financial cost.”
Tony Hunter, CEO of the Social Care Institute for Excellence, added that the guideline helps by providing a joint script and practical advice with “clear and specific recommendations” for health and social care staff working in hospitals and the community, often in testing circumstances.