Delayed Discharges
Statistical Publication Notice
26 February 2008
Delayed Discharges in NHSScotland (formerly Patients Ready for Discharge)
figures from the January 2008 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 January 2008. 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 323 patients at the January 2008 census, a reduction of 85%. The latest figure of 323 is 102 less than the number (425) at the October 2007 census and 283 less than the number (606) at the January 2007 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 168 cases at the January 2008 census and 185 cases at the October 2007 census, compared with 275 at the January 2007 census.
The patients exercising statutory right of choice principal reason category declined from 61 to 13 cases, accounting for nearly 50% of the total decrease for all reasons from the October 2007 census to the January 2008 census.
DETAILED FINDINGS
The number of patients still waiting to be discharged from hospital outwith the six week discharge planning period in the various principal reason categories for the delay were as follows:
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The number of patients still waiting to be discharged from hospital outwith the six week discharge planning period in the various principal reason categories for the delay were as follows:
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Availability of a care home/specialist residential facility placement: a decreased to 168 cases at the January 2008 census from185 at the October 2007 census. There were 277 cases at the January 2007 census.
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Community Care Assessment: numbers increased to 51 cases at the January 2008 census, compared with 44 at the October 2007 census. There were 92 cases at the January 2007 census however.
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Legal/Financial reason: there were 4 cases at the January 2008 census compared with 8 cases at the October 2007 census and 16 at the January 2006 census
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Patients awaiting funding for a care home placement: numbers decreased to 36 cases at the January 2008 census from 56 cases at the October 2007 census and 75 cases at the January 2007 census.
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Patients’ exercising statutory right of choice: this was the largest reason category absolute decrease from October. There were 13 cases at the January 2008 census compared with 61 cases at the October and 59 at the January 2007 census.
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Patients waiting to go home: numbers decreased to 34 cases in the January 2008 census compared to 50 cases at the October 2007 census and 51 cases at the January 2007 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
Anne Stott
Information Analyst
0131 275 6820
Anne.Stott@isd.csa.scot.nhs.uk
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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:
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Social care reasons
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Healthcare reasons
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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:-
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the completion of the community care assessment may take place
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the patient may be discharged from hospital
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the patient may be transferred to another health specialty if their assessed need determines this
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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:
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, 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 ACCES 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: 27 November 2007
Next Due: 27 May 2008
Data Available Since: The first census was taken on the 15 September 2000 and the report is available at http://www.isdscotland.org/delayed_discharges
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Kieran Hudson
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