Discharge papers

Patient discharge: a communication problem?

13,000 hospital beds - that’s one in seven - are filled with patients declared fit to discharge by doctors but can’t leave because of staff shortages and poor coordination across the system. This is costing the NHS around £5.5 million a day. 

Whilst plans are being put in place to create more social care packages and retrain and recruit more social care staff, how can technology help improve the flow of patient discharge to free up space in hospitals, so that they can move through the backlog faster?

Delayed transfer of care

The steps involved in discharging a patient are numerous, and all rely on the ability to communicate between teams and services. At each stage of discharging a patient, the possibility for delay increases as the wait time for responses or requests for information increases. For example:

  1. A discharge coordinator needs to be able to access patient information and quickly communicate next steps to patients, carers, family members or other healthcare providers
  2. The ward pharmacist may need to verify a patient's take home medications
  3. Referrals to community or social care may be required for continued treatment
  4. The medical team must inform the patient’s GP of the discharge and treatment plan

The sheer number of people required for the safe discharge of one patient also increases the likelihood of delay, particularly when most communication happens via laborious methods, like in-person conversations, back and forth phone calls, letters, notes and emails. 

NHS England has tried to address this through the 2022 Delivery plan for tackling the Covid 19 backlog, to “ help our staff [by] investing in digital technology that reduces the time they spend on paperwork”, adding that investment in such technologies can “rapidly realise productivity savings.” But clearly more needs to be done, and fast. Health Secretary Thérèse Coffey’s recent ‘Our Plan for Patients’ focuses on funding for social care, but more can still be done to put the right tech in place that gives trusts a better handle on patient flow and the elective backlog. 

Simple tech like SMS messaging, email and eventually messaging via the NHS App can be easy to implement and simple for both healthcare teams and patients to use. It can make a world of difference during resource strapped times and limited bandwidth for innovation. 

Building better communication bridges 

In primary care, we’ve seen a huge advance of patient communication happening outside of usual face-to-face appointments, for example sending text messages and running video consultations. This same need to contact patients and other healthcare professionals exists outside of primary care, yet these methods still aren’t used widespread across the system. Better communication bridges need to be built across the entire healthcare system, so that any healthcare professional can easily contact the right person in any organisation, or view necessary information about a patient no matter where they are registered. 

How this works in practice 

For example, once a patient is ready to be discharged, a text message can be sent to their carer or family members including NHS advice and care plans in a secure digital attachment. This means patients and carers can easily refer back to advice and information in one place. 

Two-way messaging can also be used to easily contact a patient’s carer and request photos of the home environment and descriptions of equipment available to determine whether the patient will have everything they need to support their recovery outside of hospital. And if photos aren’t enough, video consultations can be used to make quick assessments of home environments. Follow-up reviews can also be done through two-way messaging, simply through requesting patient responses including text or photo messages. Clinicians can also share links to Patient-Initiated Follow-Up (PIFU) with patients, to help support them to initiate their own care. Their responses can be managed in a shared team inbox, where follow-up actions can be coordinated between teams.

For staff dealing with long waiting lists for beds in wards, combined with the pressure to safely and efficiently discharge patients as soon as they are ready to go, it’s vital that everyone involved in that patient’s care can communicate easily. Whether that's a hospital pharmacist viewing a clear record of medication, or a clinician across a specialty discussing care plans remotely or being able to monitor patients’ recovery at home while keeping them on a virtual ward, the communication and organisation around patient’s discharge needs to be simplified, to reduce delayed transfer of care and keep the backlog moving. 

There are clear, and proven, opportunities for simple tech to streamline these ways of working and reduce the burden on hospitals. These can be implemented quickly, without huge organisational change. So what are we waiting for? 

NHE March/April 2024

NHE March/April 2024

A window into the past, present and future of healthcare leadership.

- Steve Gulati, University of Birmingham 

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Ep 42. Leadership in the NHS

In episode 42 of the National Health Executive podcast we were joined by Steve Gulati who is an associate professor at the University of Birmingham as well as director of healthcare leadership at the university’s Health Services Management Centre.