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Risk of unsafe discharge 'increased by teams in panic to find beds'


Dedicated discharge teams who “sweep around the wards looking for beds” increase the risk of unsafe discharge, the head of the Royal College of Nursing has told a committee of MPs.

As part of an investigation by MPs into unsafe discharge, RCN chief executive Janet Davies described how a culture of “almost panic” and pressure to free up beds could harm patient care.

She gave evidence this week to the Commons’ Public Administration and Constitutional Affairs Committee, which launched the investigation in response to a critical report by the Parliamentary and Health Service Ombudsman into unsafe discharge from hospital.

“When the focus is on beds rather than the person, that’s when we sometimes find difficulties [with discharge]”

Janet Davies

The report highlighted examples where patients had been discharged when they were not well enough to leave or families had not been informed when vulnerable relatives were sent home.

Ms Davies said these cases were “totally unacceptable” but added problems were more likely if professionals involved in the discharge process did not know the patient yet were “coming in and pushing for a discharge”.

“When the focus of the whole organisation is on the people in that organisation – the patients and carers – then we don’t see that, we see really good discharge,” she said.

“Having enough community nurses and investing in community services can only help the hospitals but it is seen as very separate”

Janet Davies

“When the focus is on beds rather than the person, that’s when we sometimes find those difficulties. When we have got discharge teams, for instance, that might sweep around the wards looking for beds because of the pressure at the front of the hospital,” said Ms Davies.

“You can understand why people do that but actually it is the incorrect way of assessing people who are ready for discharge,” she added.

She said it was better if discharge was initiated by a multi-professional team that knew the patient well.

Mistakes were more likely to be made “when we have this culture of almost panic – we’ve got people coming in, we’re going to get penalised for the wait, we need to get people out”, she told the MPs.

Janet Davies

Janet Davies

Janet Davies

She went on to highlight other issues that can affect safe discharge of patients from hospital, including ongoing lack of integration between acute and community services, lack of social care packages and shortages of community nurses.

“Having enough community nurses and investing in community services can only help the hospitals but at the moment it is seen as very separate,” she said.

She also highlighted the need for staff training in areas like mental capacity assessment after the ombudsman’s report revealed cases where people with dementia had been discharged without the right support in place.

Meanwhile she said people should not be discharged at night unless it was at their request. She said the RCN was currently working with Healthwatch England to find out how often this happened.

She said there was anecdotal evidence there were fewer instances than feared and some may be down to recording issues.

The chief nursing officer for England, Jane Cummings, also gave evidence to the committee and said case studies in the ombudsman’s report, which included those where health professionals had failed to communicate with families, “make for incredibly distressing reading”.

“Actually having people that are permanent members of staff working in teams has a much better outcome”

Jane Cummings

However, she said she’d found communication was a generally key priority for the frontline nurses she met.

She highlighted the importance of reducing reliance on agency staff and using technology effectively to free up nurses’ time.

“Actually having people that are permanent members of staff working in teams has a much better outcome in terms of patient care, patient experience and staff experience,” she said.

Committee chair Bernard Jenkin said the evidence heard so far suggested staffing shortages could not be blamed for poor discharge processes.

“If you haven’t got enough resources you just have to do things differently,” he said. “It is not an excuse for abdicating your responsibilities.”


Readers' comments (4)

  • Oh for goodness sake, what's new? Spent my last 15 years as discharge manager in the NHS working to this premise I.e. Work together with patient and family at the centre, to ensure and plan SAFE discharge from admission, within a dedicated multidisciplinary discharge team. It's not rocket science!

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  • It may not be rocket science but sadly discharging patients, at times without even informing next of kin still happens.
    At my local hospital, the minute the doctor says you can go home they evict you from your bed, strip it and prepare it for the next patient, even if it will be several hours before a relative can come and collect you.
    Please don't assume that good practice in your hospital happens everywhere, I can assure you it doesn't!

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  • milton pena

    Sadly unsafe discharge of patients from hospital wards will continue to occur. Closure of beds in wards; closure of entire wards; or worse still- closure of hospitals over the years has reduced capacity to the point that hospital 'capacity crisis' are a weekly or even daily occurrence. This is compounded by the shortage of nurses [ measured against planned staffing] during between 10 and 30 percent of shifts.
    In parts Two and Three of my book: 'The Flight of the Black Necked Swans' I describe these issues. Nurses should ask their local libraries to stock it. [See article from Nursing Times regarding this book]

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  • The acute health system runs so much faster than recovery of our more vulnerable society. Where demand outstrips capacity (an every day occurrence these days) try reconfiguring a ward into a MDT discharge planning ward. Staffed with a MDT interested in rehabilitation and safe transfer, with a cap on LOS, this model works well and was positively evaluated by patients and staff alike. Patients are transferred following assessment by the discharge staff ward team, and doctors can continue to be responsible for their care whilst patients become "safe to transfer" to a step down facility or home, post acute phase. A definition of "safe to be transferred" is agreed across all disciplines with patients at the centre of their discharge plan.

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