Page last updated: 27-NOV-2007

Delayed Discharges


Statistical Publication Notice

27 November 2007

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Delayed Discharges in NHSScotland (formerly Patients Ready for Discharge)
figures from the October 2007 Census.   


INTRODUCTION

This report provides the latest statistics on NHS hospital inpatients "ready for discharge" but whose discharge has been delayed, from a census of these patients as at the October 2007.
 
A delayed discharge occurs when a patient, clinically ready for discharge, cannot leave the hospital because the other necessary care, support or accommodation for them is not readily accessible and/or funding is not available, to purchase a care home place, for example.
 
Patients are categorised according to the main reason for their continuing stay in the hospital ward at the time of the current census. Explanation of the technical terms used in this notice are in the glossary below.

KEY POINTS

There has been a considerable decrease in the number of patients delayed outwith the six week discharge planning period over the last six years. The October 2001 census is the point when the figures were at their highest, there were 2,162 patients delayed compared to 425 patients at the October 2007 census, a reduction of 80%. The latest figures of 425 are 2 higher than the number (423) at the July 2007 census and 254 less than the number (679) at the October 2006 census.
 
The largest ‘principal reason for delay’ group of patients delayed outwith the six week discharge planning period, concerns availability of a care home/specialist residential facility placement. There were 185 cases at both the October 2007 and the July 2007 censuses, compared with 300 at the October 2006 census.

INTERPRETATION

From October 2007 four changes have been made.
 
A new Complex Needs code has been introduced (code 71X) for patients exercising statutory right of choice – where an interim placement is not possible or reasonable. This code covers a limited number of cases where an interim move under the choice of accommodation guidance is deemed to be unreasonable for the patient.  This may be where reasons of extreme distances or transport infrastructures make visiting residents impossible.  This code should only be applied where remaining in a hospital setting is the only viable alternative.
 
All complex needs cases (excluding those delayed due to requirements of the Adults with Incapacity Act (code 51X), are formally reported to ISD and the Scottish Government by Directors of Social Work, NHS Board Chief Executives or their nominated representatives. A narrative of what is being done to facilitate discharge for the patient should also be provided. All Complex Needs cases are reported separately as a supplement to this report [see Appendix 5].
 
Information on out of area cases by NHS Board of treatment will be included [see Appendix 6].
 
There have been some minor changes to the description of some definitions and also to reason for delay codes [see Appendices page 27 for a summary of the coding changes and the Definitions and data recording manual at http://www.isdscotland.org/isd/files/Revised_data_definitions_recording_manual_Oct07.pdf ].

DETAILED FINDINGS

The number of patients delayed outwith the six week discharge planning period in the various principal reason categories were as follows:
 
  • Availability of a care home/specialist residential facility placement: has remained constant at 185 cases from the July 2007 census to the October 2007, compared with 300 at the October 2006 census.
  • Community Care Assessment decreased, there were 44 cases at the October 2007 census, compared with 59 at the July 2007 census, and 93 at the October 2006 census.
  • Legal/Financial reason categories decreased, there were 8 cases at the October 2007 census, compared with 10 at the July 2007 census, and 25 at the October 2006 census.
  • Patients awaiting funding for a care home placement has remained fairly constant, there were 56 cases at the October 2007 census, compared with 55 at the July 2007 census, and 73 at the October 2006 census.
  • Patients’ exercising statutory right of choice increased, there were 61 cases at the October 2007 census, compared with 52 at the July 2007 census, and 72 at the October 2006 census.
  • Patients’ waiting to go home increased, there were 50 cases at the October 2007 census, compared with 39 at the July 2007 census, and 71 at the October 2006 census.
    [The definition of principal reason can be found in the Data Definitions and Recording Manual at http://www.isdscotland.org/isd/2359.html ].


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MAIN CONTACTS:

Kieran Hudson
Information Analyst
0131 275 6130
kieran.hudson@isd.csa.scot.nhs.uk

Lorna Jackson
Head of Programmes
0131 275 6419
 
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GLOSSARY:

Delayed Discharge
A delayed discharge is experienced by a hospital inpatient who is clinically ready to move on to a more appropriate care setting but is prevented from doing so for various reasons. The next stage of care covers all appropriate destinations within and outwith the NHS (patient’s home, nursing home etc). The date on which the patient is clinically ready to move on to the next stage of care is the ready-for-discharge date which is determined by the consultant/GP responsible for the inpatient care in consultation with all agencies involved in planning the patient’s discharge, both NHS and non-NHS (Multi-Disciplinary Team).   Thus the patient is ready-for-discharge, but the discharge is delayed due to:
  • Social care reasons
  • Healthcare reasons
  • Patient/Carer/Family-related reasons.
  • Patients delayed  more than 6 weeks
It has been agreed for non-short stay facilities that there is a period of 6 weeks beyond the clinically ready for discharge date during which all assessment and follow-on arrangements are expected to be put in place.  During this period:-
  1. the completion of the community care assessment may take place
  2. the patient may be discharged from hospital
  3. the patient may be transferred to another health specialty if their assessed need determines this
  4. the patient may be transferred to another health specialty to await discharge from hospital.
Each local Partnership agreement is designed to reflect local circumstances and arrangements for safe and appropriate transfers of patients to the next stage of care.  For this reason the SGHD, recognising the complexity which can surround the discharge planning and assessment process, have advised that figures should distinguish between those who are delayed within 6 weeks and those delayed for more than 6 weeks. The figures for over six weeks should be published in comprehensive form in the quarterly figures. 
Data for all patients determined by the consultant/GP responsible for their care to be clinically ready for discharge should continue to be included in the monthly and quarterly censuses from the clinically ready for discharge date.  ISD will comprehensively report data only for those patients who have been clinically ready for discharge for more than 6 weeks, irrespective of the reason for delay.  Data will be provided in summary form, on patients who have been clinically ready for discharge for 6 weeks or less. ‘total’ numbers of patients ready for discharge including those patients with a delay of less than six weeks at the time of the census will continue to be published.
 
Ready for-discharge date
Ready-for-discharge date is the date on which a hospital inpatient is clinically ready to move on to a more appropriate care setting. This is determined by the consultant/GP responsible for the inpatient medical care in consultation with all agencies involved in planning the patient’s discharge, both NHS and non-NHS (Multi-Disciplinary Team). The Team must be satisfied that it is safe and reasonable to transfer/discharge the patient.  A patient who continues to occupy a hospital bed after his/her ready-for-discharge date during the SAME inpatient episode experiences a delayed discharge.
Notes:
  1. Ready-for-discharge date and discharge date are used to measure the total duration of delay experienced by the patient.  The calculation is: “Discharge Date minus Ready-for-Discharge Date”.
  2. “A more appropriate care setting” covers all appropriate destinations outwith short-stay specialties and outwith the NHS (patient’s home, nursing home etc).
  3. From a service provider’s perspective an “appropriate care setting” can de defined as a place that:
    • Meets the particular care needs of a person.
    • Meets those needs cost effectively.
  4. If a patient who is clinically ready for discharge is being transferred for non-clinical reasons to another NHS facility whilst awaiting final discharge (which will result in the start of another NHS episode) i.e. to free up short-stay beds beds, the original Ready for Discharge date should be recorded.
Reason
This is the reason why the patient has remained in the bed awaiting the finalisation of arrangements for his/her safe transfer. For the national census, the principal reason that applies to each patient at the census point is recorded.  
 
Social Work Involvement
A patient ready for discharge is considered to have Social Work involvement if: EITHER - he/she has Principal Reason 'Community Care Assessment' or 'Community Care Arrangements'; OR - he/she has Principal Reason in the 'Patient/Carer/Family - related' categories, OR Principal Reason not agreed, OR Principal Reason not recorded AND a date of referral for Social Care Assessment has been recorded.
 
Duration
This is the period of time to the census point that the patient has remained in the bed awaiting the finalisation of arrangements for his/her safe transfer.
Median/mean duration presentation, and frequency distribution
This publication presents information on durations up to the census point. Two summary measures are provided:
Median duration - the middle value of any one set of duration values that are arranged in numerical order.
Mean duration - an average duration, calculated by summing all duration values in any one set and dividing by the number of cases in that set.
The frequency distributions for duration commonly show a relatively large proportion of cases experiencing fairly short durations and a relatively small number with longer durations. The median may therefore be taken as the best indicator of a "typical" duration for patients in a particular group (eg a particular NHS Board, or a particular reason category).
 
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PRE-RELEASE ACCESS TO THIS PUBLICATION WAS GIVEN TO:

NHS Chief Executives
Directors of Social Work
NHS Contacts
Local Authority Partner Contacts
NHS Leads
NAGoDDI Representatives.
 
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HISTORY OF THIS PUBLICATION:

Last Published:  28 August 2007
Next Due:  26 February 2008
Data Avaliable Since:  The first census was taken on the 15 September 2000 and the report is available at  http://www.isdscotland.org/delayed_discharges


Main contact: Email Delayed Discharges