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Elderly hospital deaths prompts review


Statistics show that many elderly patients die in hospital while waiting to be discharged.

Health secretary Nicola Sturgeon said she has written to NHS boards after revelations that 93 patients died in Fife last year despite being passed ready to leave.

In a statement to parliament on the issue, she said: “We have a duty to enable (elderly people), when clinically fit to do so, to return to an appropriate homely setting after a stay in hospital.

“In my view, in order to underline how important it is to avoid such situations arising, and to ensure that the focus remains at all times on reducing delayed discharges, that when a patient has been deemed fit for discharge and subsequently dies before discharge takes place, the medical director of the relevant NHS board should ensure that the circumstances are always fully reviewed.

“I’ve written to boards advising them that this should be the practice and that I expect boards as part of the clinical governance arrangements to receive regular updates.”

The figures for Fife emerged at the weekend following freedom of information requests by Labour MSP Dr Richard Simpson.

He said: “I would never have imagined that so many people would pass away while waiting for an appropriate care package.”

Ms Sturgeon said the number in Fife was unacceptably high but described a falling trend since the Scottish Parliament was established.

She said 646 people were kept in hospital beyond the six-week target in April 2005, under the Labour-Liberal Democrat administration, while the numbers were at zero at the April census from 2007 onwards, under the SNP.

The latest figure, from October last year, showed there were 128 patients waiting beyond the limit.

“Let me be absolutely clear - that was far too high,” she added.

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Readers' comments (6)

  • Does this indicate that once the doctors have declared 'no further medical need and waiting for discharge' nurses just forget them and don't focus on the fact that these elderly people might still have a healthcare need - one which is a NURSING NEED.

    Oh dear - hear we go again.

    Is this about poor nursing care, poor nursing management, inadequate nurse education and competencies, low staff/patient ratios, weak nursing management and leadership re patient/staff ratios etc... etc....

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  • why is that when you walk into some wards there are so many staff milling around chatting when patients cannot get the attention they need?

    and then we hear complaints from staff of desperate shortages and being unable to cope with demands. maybe the problem of distribution of human resources in the nhs
    should be closely examined.

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  • it is simply not acceptable in a public funded service which needs to be cost-effect to have over-staffing in some areas
    and poor standards of care due to shortages in others.

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  • It's well known that the longer someone is in hospital the more likely they are to develop complications, be it an infection or otherwise. This is especially found in care of the elderly. I don't believe they get forgotten, but wards caring for the elderly are generally less well staffed (nurse-wise) that acute medical and surgical wards. It shouldn't be blamed on the nurses, wards are run as multi-professional care units, but often the need for no longer requiring medical care (but the Drs still see them), seems to mean no further MDT care either, so their care is solely delivered by nurses. I have a true belief that if MDT working was implemented as intra-disciplinary care' then a lot of care would not be 'duplicated'. Research shows that rehabilitation which is purposeful to the patient reaps better outcomes. Instead of walking someone up and down the corridor, walk them to the toilet or the dining room, or to the OT kitchen for therapy. Therapists could position people for meals, assist with specialised cutlery at mealtimes and help with feeding. Too much responsibility and onus is put on the nursing staff to provide these needs. If you count therapists into the staff numbers them you could have a 1:2 staff ratio, in some cases almost 1:1. The downside if such a notion is successful, then there would probably be staff cuts. OTs no longer do a home assessment until the patient no longer needs medical care, social workers are not involved until the same time either, then the discharge team have to do their assessment. Whatever happened to 'single assessment'? Having said that, it never happened, did it? The process, like everything else in the NHS, relates to short term fixes and a longer term waste of resources, for staff and patients alike.

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  • from experience delays are often due to social services and out side agencies along with the the ridiculous amount of paperwork it takes to get help for a person to go home or into care, rather than the multidisciplinary team within the hospital.

    Most elderly have complex needs and applying the continuing health care often creates delays waiting for meetings to occur, often people chairing these meeting refuse to do them before the patient is medically fit because they feel the patients potential/needs may change.

    It is not just nurses, Drs have a role too do they just declare a patient medically fit without warning or do they create workable plans?

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  • Anonymous | 11-Feb-2011 10:47 pm
    Anonymous | 12-Feb-2011 7:51 pm

    I agree with both, there are historical ways of working and having hands tied and complex processes in getting people discharged. Drs do a ward round and suddenly inform the MDT that the patient no longer needs their input. I remember the days when OTs were 'allowed' to do a home visit so they knew what they were dealing with if the patient was able to return home or not. Now it is delayed until the Drs declare there is no longer a medical need for hospitalisation, as is social worker intervention. These are just two examples of short term insight into complex care needs and the time it takes to implement them.

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