Staffing levels in community teams must be sufficient to ensure patients can be safely discharged from hospital at the weekend, according to a new report.
It is just one of a series of recommendations included in a detailed analysis of hospital discharge processes, which was published last week by the Queen’s Nursing Institute.
The Department of Health-funded research was based on surveys of community and hospital nurses and focus groups. Carried out by Queen’s Nurse Candice Pellett, the analysis identified poor communication and lack of co-ordination between services as key issues hampering smooth discharge.
The headline findings were exclusively revealed by Nursing Times in November last year.
Since then, Ms Pellet has made recommendations for commissioners, providers and frontline nursing teams, which are set out in her final report.
“Problems could be avoided if a suitable level of staffing and services were in place, not only on Fridays but at weekends too”
These include ensuring “appropriate staffing levels in the community” to allow for Friday and weekend discharges.
Nurses who took part in the research made “numerous comments” about poor discharge planning for patients going home from hospital on a Friday, stated the report.
“However, nurses also confirmed that problems could be avoided if a suitable level of staffing and services were in place, not only on Fridays but at weekends too, thereby preventing readmission to hospital due to lack of planned support after discharge home on a Friday,” it added.
The report also highlighted the need to begin discharge planning “on or soon after patient admission” and stressed the importance of involving community teams, especially when patients were frail or elderly.
“The hospital-based multidisciplinary team should always seek ways to collaborate more closely with the local community teams to facilitate timely discharge,” said the document.
“There needs to be willingness from nurses – both in hospital and community – to improve partnership working”
Alert systems should be developed to inform district nursing teams when an existing patient on their caseload is admitted to hospital.
Meanwhile, patients should be given more information when discharged from hospital, including about the role of the local community nursing service.
The report recommended that a named nurse or key worker from the community should be responsible for tracking that person and co-ordinating their care, working with the patient and their family.
“This recommendation was cited many times within the focus groups as an example of how to improve practice,” noted the report.
“An example of a key worker for a patient being cared for at home at the end of their life would be the district nurse, who would ensure co-ordination of the delivery of all health and personal care services, preventing any duplication of visits and minimising the disruption to the family,” it said.
More joint working is also needed between different teams to ensure patients are not left waiting for medication, equipment, social care assessments or discharge letters, according to the report.
Top district nurse to lead ‘nationally important’ discharge planning work
Speaking on her final report, Ms Pellett said: “Three key themes emerged which would enable effective discharge planning: improved communication, improved co-ordination of services and improved collaboration.
“It is recommended that commissioners and provider organisations examine the local processes they have in place for discharge planning, ensuring that transfer of care between services is planned around the needs of patients, families and carers at all times,” she said.
“At a practitioner level, there needs to be willingness from nurses – both in hospital and community – to improve partnership working, to ensure that patients, carers and families experience a seamless service when discharged from hospital to home, with good discharge planning and post-discharge support,” said Ms Pellett.
“Nurses in every part of the NHS and care systems are at the heart of effective discharge planning and must continue to be the advocate for the patient the pursuit of excellent practice in transfers of care,” she added.