Organisation and features of hospital, intermediate care and social services in English sites with low rates of delayed discharge

Abstract

In recent years, there has been significant concern, and policy activity, in relation to the problem of delayed discharges from hospital. Key elements of policy to tackle delays include new investment, the establishment of the Health and Social Care Change Agent Team, and the implementation of the Community Care (Delayed Discharge) Act 2003. Whilst the problem of delays has been widespread, some authorities have managed to tackle delays successfully. The aim of the qualitative study reported here was to investigate discharge practice and the organisation of services at sites with consistently low rates of delay, in order to identify factors supporting such good performance. Six 'high performing' English sites (each including a hospital trust, a local authority, and a primary care trust) were identified using a statistical model, and 42 interviews were undertaken with health and social services staff involved in discharge arrangements. Additionally, the authors set out to investigate the experiences of patients in the sites to examine whether there was a cost to patient care and outcomes of discharge arrangements in these sites, but unfortunately, it was not possible to secure sufficient patient participation. Whilst acknowledging the lack of patient experience and outcome data, a range of service elements was identified at the sites that contribute to the avoidance of delays, either through supporting efficiency within individual agencies or enabling more efficient joint working. Sites still struggling with delays should benefit from knowledge of this range. The government's reimbursement scheme appears to have been largely helpful in the study sites, prompting efficiency-driven changes to the organisation of services and discharge systems, but further focused research is required to provide clear evidence of its impact nationally, and in particular, how it impacts on staff, and patients and their families.

Care transitions for frail, older people from acute hospital wards within an integrated healthcare system in England: a qualitative case study

“…As in previous research [28, 31], participants expressed concerns that frail older people were at risk of deteriorating and acquiring infections during their long stays in acute wards. The current study also highlighted that frail older people were frequently moved between acute wards, an issue that has been raised for several years in England [17, 46, 54, 55] and the US [23]. The formation of a quality relationship between practitioners and frail, older people and their relatives supports positive transition experiences [10] but frequent moves affect relationship-building.…”

“…While the patient sample gave some valuable perspectives of transitions at individual and interpersonal level [36], a limitation of the study is the very small sample. Baumann et al reported problems in recruiting participants from a similar population [46]. The recruitment difficulties confirmed that many frail older people were remaining in acute hospital wards for lengthy periods and illuminated the complexity of these patients, as many were neither well enough, nor had the mental capacity, to be able to participate in an interview.…”

Sociodemographic, clinical and organisational factors associated with delayed hospital discharges: a cross-sectional study

“…Among organisational factors of delay, some studies emphasise the role of both hospital and primary care processes [13,14]. Hospital discharge is indeed appropriate when the patient does not exhibit evolving clinical symptoms and is assisted after the acute stage of illness through processes that involve different professionals and both health and social facilities [15,16]. …”

A realistic evaluation of fines for hospital discharges: Incorporating the history of programme evaluations in the analysis

“…Consequently, the findings from this local implementation will state something about the broad programme theory ('fines work to reduce delayed discharges') as a general theory of change, thus, a number of transferable lessons can be learned from everybody and for everybody. (Baumann et al, 2007) intending to fill the evidence gap regarding solutions to delays. This research analysed sites performing 'exceptionally well' with regards delayed discharges and it drew general knowledge from their practices.…”