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Poor discharge leaving vulnerable patients 'bewildered'


Patients leaving hospital that are older, homeless or have mental health problems are often being left “frustrated” and “bewildered” with tragic consequences in some cases, according to a new report revealing the extent of poor discharge in England.

An inquiry – led by national consumer champion in health and care Healthwatch England – gathered evidence from more than 3,000 people about their sometimes “shocking” experiences.

“Less than half [of 120 trusts] check whether people have a safe home to go when discharged, or whether there is basic food, water, heating etc.”

Healthwatch England

The report, called Safely home: What happens when people leave hospital and care settings?, identified a lack of involvement of people in decisions about their care and also too little understanding among families and patients about the extra support required.

In one instance, the report claimed that a patient with severe depression and anxiety was discharged from hospital after saying he did not want to go home and was told he could not return if he felt unable to cope.

He was given an appointment for further assessment a week later, but within a few days he had committed suicide.

Basic communication failures between hospitals and community care providers were also noted, leading to patients dying in a place that was not their choice or without the level of support they required.

The inquiry found in one case that an older patient left hospital to go to a care home, but the home was not notified she required palliative care and did not receive the nebuliser she needed, while the nursing care member of staff failed to record her discharge plan.

“Joint action now can deliver the step change needed to make significant improvements to the experiences of people leaving hospital and care settings”

Healthwatch England

In her online submission to the inquiry, the patient’s mother said: “It was appalling. My mother could’ve had a much more peaceful and dignified death.”

Meanwhile, homeless people were often discharged without accommodation in which to recover, said the report.

Focus groups with homeless patients carried out during the inquiry said they were discharged before they were ready and that staff were often ill equipped to advise them on their options as homeless people.

Less than half of 120 trusts responding to Freedom of Information Act requests by the national body Healthwatch England said they routinely checked whether people have a safe home to go to when discharged and whether they have basic food, water and other means.

In addition, around a third of these trusts did not ensure notes about new medication were properly recorded and passed on to GPs or carers, and 10% did not routinely notify relatives and carers that someone has been discharged.

Other problems identified were that some patients – particularly homeless people – feel stigmatised and discriminated against by staff.

Patients also noted frustration that staff did not deal with their full range of needs, such as both their physical and mental health, or other issues such as their housing or financial situation.

Homeless man in street with dog

Healthwatch England questioned the slow progress on improving discharge in England and said collaboration between providers, clinical commissioning croups and health and wellbeing boards was required to drive change.

“We believe that joint action now can deliver the step change needed to make significant improvements to the experiences of people leaving hospital and care settings,” it concluded.

Royal College of Nursing chief executive and general secretary Peter Carter said: “Sadly this will not come as a surprise to nursing staff, who all too often discharge a healthy patient only to see them return to hospital with complications caused by a lack of community care and support.

“With the right support in the community, and properly resourced staff who can be responsible for coordinating discharge, patients are less likely to return to hospital, relieving the pressures on the frontline,” he said.


Readers' comments (6)

  • we ask a patient if they have all the support they will need . the patient , desperate to get home , says yes . they arrive home and there family say why have they let you out . we need to ascertain who is going to give the support and speak to them not just the patient .

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  • The Queen's Nursing Institute became aware of the extent of this problem from our 2014 survey of District Nurses (2020 Vision Five Years On). We are currently undertaking a project, with DH funding, to look at this issue from a District Nursing perspective to see how hospital discharge arrangements can be improved, particularly the liaison between hospitals and District Nurses. District Nurses play a vital role in caring for vulnerable patients when they return home, and liaise with many other services in the community.

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  • I have noticed that elderly people get as much help as possible arranged before discharge however, middle aged or young even if they have no one or no where to go just gets discharged.
    The elderly people though medically fit block acute bed spaces throughtout the hospital.
    We need to have plans for all vulnerable people regardless of age. That is a civilised way otherwise we will be having social problems that are more difficult to sort.

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  • I work as a staff nurse in a Discharge Lounge in a large teaching hospital.
    A common perception of Discharge Lounges seems to be that of an area in which patients simply wait for transport, the discharges having been sorted out on respective base wards.
    If only this were the case. .
    As with many things I think the reasons behind poorly executed discharges are multi factorial, the main one being the ever present pressure to create beds, coupled with the unmanageable work load of nursing staff on the discharging wards. These factors will not change so scrutiny is needed as to what elements can be improved. I have three, relatively simple ideas.
    1. Cull the paper blizzard of documentation, especially pre-printed care plans and really sort out what information is needed and of use. Have all information pertinent to discharge clearly documented on a well designed form/ or entered electronically.
    2. Make the post of Discharge Co-ordinator a registered nurse role, so the whole is owned by that person enabling better communication, District Nurse referrals, GP involvement etc, then follow up the discharge by communication with the patient/ family/carers.
    3.Task social services with the responsibility of clearly documenting discharge information, contact details, exactly who is providing care packages etc.
    I spend hours every week trawling through medical and nursing notes trying to find out information re times of care packages, providers of, next of kin details, who has a key to the property etc.
    Simple documentation of the needed information would enhance safety, patient experience and safe discharge.

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  • I am a nurse but now work as a care manager for Adult Services in an acute hospital. We have always encouraged our team to write in patients notes. We now have a blue sticker so that it can been seen straight away. Recording the discharge plans, whats been arranged, who the provider is , what time the patient needs to be home by and if a snack box is needed. Even doing this, it can still result in delays or information not passed on, and unnecessary phone calls when the information is there. Its not perfect and I know more can be done but its a start in the right direction to ensure a safe discharge.

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  • get your act together. nobody cares about patients it is all about targets, figures and reducing beds and services to save money.

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