The National Audit Office (NAO)’s report on delayed discharges from hospital clarifies the extent to which such delays cause unnecessary harm to older patients and waste NHS money. Delays in discharging older patients cost an estimated £820 million per year, whilst increasing risks of harm to older patients through loss of mobility during long stays. Delays arising from waits for nursing home places or home care are increasing.
Section headings comprise:
- Part One: Delays in discharging older patients from hospital.
- Part Two: Managing discharges for older patients.
- Part Three: The effectiveness of local health and social care systems.
- 62% of hospital bed days were occupied by older patients (those aged 65 or over) in 2014-15. An 18% increase in emergency admissions of older people between 2010-11 and 2014-15 (compared to a 12% increase for whole population).
- £820m gross cost to the NHS of older patients in hospital beds when no longer in need of acute treatment.
- 2.7 million hospital bed days occupied by older patients no longer requiring acute treatment.
- 1.15 million bed days lost by delayed transfers of care in acute hospitals during 2015 (up 31% since 2013).
- Average length of stay for older patients in 2014-15 was 11.9 days.
- Older people can lose 5% of muscle strength per day of hospital treatment.
- 54% hospitals assert that discharge planning is not started fast enough to minimise delays / harms for most older patients.
Triggle, N. (2016). NHS ‘must get a grip on hospital discharge delays’. London: BBC Health News, May 26th 2016.
This relates to:
The Comptroller and Auditor General of the National Audit Office: Morse, A. (2016). Discharging older patients from hospital. National Audit Office Report (HC 18). Session 2016-17. London: The Stationery Office [Department of Health / National Audit Office (NAO)], May 26th 2016.
There is also an Executive Summary.
A recent headline describing the seeming intractability of the problem:
Bed-blocking delays may continue ‘up to five years’. London: BBC Health News, June 7th 2016.
Hospital-Associated Deconditioning (Deconditioning in Hospital)
A BBC Radio 4 broadcast on the benefits of early patient mobilisation. (Features between around 9 minutes 10 seconds and 19 minutes 40 seconds into programme).
Deconditioning in hospital. London: BBC Radio 4’s Inside Health, February 26th 2019.
Benefits of Early Mobilisation to Reduce Length of Stay in Hospital
A recent systematic review discovered that mobilisation programmes for hospital patients result in improved walking speed and a length of stay around two days shorter.
Cowley, A. [and] Fiddler, H. (2019). Getting hospital patients up and moving shortens stay and improves fitness. London: NIHR Signal, April 16th 2019.
This relates to:
Full Text Link (Note: This article requires a suitable Athens password, a journal subscription or payment for access).
Cortes, OL. Delgado, S. [and] Esparza, M. (2019). Systematic review and meta-analysis of experimental studies: In-hospital mobilization for patients admitted for medical treatment. Journal of Advanced Nursing. January 22nd 2019. [Epub ahead of print].
Capacity Tracker: Faster Checking for Availability of Care Homes Vacancies
A digital portal allows health and social care staff to obtain current information about vacancies in local care homes, thereby supporting patients in need of care home placements to be discharged from hospital more quickly.
“In 2018, around a quarter of a million hospital bed days in England were taken up by people who were medically fit enough to be discharged, but who faced delays in an appropriate care home being found that could meet their recovery needs”.
Digital tool to help reduce avoidable lengthy stays in hospital. [Online]: NHS England, April 15th 2019.