Delayed Discharges

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:

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:-

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:

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).