Delayed Discharges

Statistical Publication Notice

24 June 2008

Delayed Discharges in NHSScotland - Supplementary Information by Community Health Partnership from April 2008 census.

INTRODUCTION

This supplementary information summarises the results of the census of delayed discharges from a “snapshot” of NHS inpatients by Community Health Partnership as at the April 2008 census.

Patients are categorised according to the main reason for their continuing stay in the hospital ward at the time of the current census. Community Health Partnership is derived from the Patients postcode of residence.

Detailed findings and interpretation of the April 2008 census data can be found at http://www.isdscotland.org/isd/5648.html

-----------------------------------------------------------------

MAIN CONTACTS:

Anne Stott
Information Analyst/Statistician
0131 275 6820
Anne.Stott@isd.csa.scot.nhs.uk

-----------------------------------------------------------------

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:-

the completion of the community care assessment may take place
the patient may be discharged from hospital
the patient may be transferred to another health specialty if their assessed need determines this
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:

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”.
“A more appropriate care setting” covers all appropriate destinations outwith short-stay specialties and outwith the NHS (patient’s home, nursing home etc).
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.
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).

-----------------------------------------------------------------