Inappropriate and unplanned discharge is a particular problem for homeless people, according to community nurses working with this vulnerable group of patients.
Last autumn the QNI carried out a survey of 184 members of its Homeless Health Network to identify the main issues and challenges facing them in delivering effective patient care.
The survey identified unsafe hospital discharge as one of the biggest risk areas facing homeless patients.
“The consistent message from community nurses is that discharge services have a great deal of room for improvement”
The QNI has today published a report – What Community Nurses Say About Hospital Discharge for People who are Homeless – specifically on what it describes as this key “transition of care” period.
The problems fall into four main areas – poor communication between different services, inappropriate or unsafe discharge, lack of suitable accommodation and other problems such as lack of trust, management of long-term conditions, and in some cases lack of access to public funds.
These problems reflect those identified in a separate QNI survey of district nurses published in June. In that survey, 83% of respondents said that discharge procedures were not satisfactory.
Community nurses stated that hospitals frequently discharged patients without letting community services know, and without adequate advance notice for the preparations to be made for them to be cared for at home.
In the case of patients who are homeless or in vulnerable housing, the “problem is clearly more acute”, said the QNI.
QNI chief executive Crystal Oldman said: “Hospitals frequently admit homeless people who are not registered with a GP and who have no other recourse to health services in times of crisis.
“It is not a sustainable solution to discharge them back into the community without adequate planning for their health and welfare there,” she said.
The QNI itself has now received funding from the Department of Health to analyse the factors that impact on effective hospital discharge from a community health perspective.
Dr Oldman said the new funding would enable the institute to identify and share “excellence in practice” for discharge generally, as well as for homeless patients.
“The consistent message from community nurses is that discharge services have a great deal of room for improvement,” she said.
Meanwhile, the Queen’s Nursing Institute is also sending evidence to the national inquiry into hospital discharge for homeless people, led by Healthwatch England.
In addition, it is creating a searchable online map of national specialist homeless health services to act as a resource directory, and developing online guides for staff working with homeless people.