Hospital discharge must be improved to manage COVID-19 second peak
Are people benefiting from faster hospital discharge?
To help hospitals free up 15,000 beds and cope with demand at the peak of the pandemic, the Government issued policy to switch to a ‘discharge to assess’ model in March 2020. This meant people were discharged from hospital faster by having their ongoing care needs assessed at home.
The public is grateful for the dedicated doctors, nurses and care staff who worked hard to save lives during the early stages of the coronavirus pandemic.
However, although the speed at which people were discharged from hospital was important, it also led to worse care and a lack of support for some patients leaving hospital.
In partnership with British Red Cross, our latest report reviews the experiences of 590 people. The research exposes where the current policy is creating gaps in care and calls on the NHS to address these issues as we enter the busy winter period amidst growing pressures of a second COVID-19 wave.
What people told us
Over 500 patients and carers (paid and unpaid) took part in our survey, which gathered experiences of being discharged from hospital from March to August 2020. Eight local Healthwatch and partners around the country also carried out 61 in-depth interviews with key staff groups involved in hospital discharge processes.
Key findings included:
- 82% of respondents did not receive a follow-up visit and assessment at home and almost one in five of these reported an unmet care need.
- Some people felt their discharge was rushed, with around one in five (19%) feeling unprepared to leave hospital.
- Over a third (35%) of people were not given a contact who they could get in touch with for further advice after discharge, despite this being part of the guidance.
- Overall patients and families were very positive about healthcare staff, praising their efforts during such a difficult time.
- Around a third (30%) of people faced an issue with delayed COVID-19 test results, potentially putting family and carers at risk, or in a care home, other residents and staff.
The impact on Robin and his family
Robin’s dad was admitted to hospital with a heart attack back in June. Whilst the family were grateful for the care he received, the lack of communication and support when he was being discharged from hospital was particularly stressful.
“It was a very stressful time for us, we had to keep chasing the hospital for information. The doctors couldn’t agree on whether dad could come home. Eventually, after a week in hospital, a nurse advised dad to self-discharge, and he took a taxi home.
“We were really worried as dad hadn’t been tested for COVID-19 or given any support with aftercare. He was told to take some paracetamol and talk to his GP. We didn’t really know how to take care of him, or what signs to look out for in case there was a problem.”
Our recommendations
To help hospitals manage a second wave of COVID-19 hospital admissions ahead of winter, we have made several recommendations based on the experiences of people and staff, including:
- Post-discharge check-ins and assessments: Services should follow policy and ensure people are offered follow-up support soon after discharge, whether by phone or in person.
- Discharge checklists: Patients should be asked about the support they need, including any transport home and equipment required.
- Communication: Patients and carers should be given a single point of contact for further support or questions, in line with national policy.
- Medication: Waiting for medication can often lead to delays being discharged from hospital. Linking patients to voluntary sector partners or community pharmacists who can deliver medicine could avoid delays.
- Boost community care capacity and recognise the value of the voluntary care sector in hospital discharge: The current discharge policy depends on follow-up assessments and care being available. Longer-term, more investment is needed to ensure this happens, including in the voluntary care sector.
Commenting on the findings, our Chair Sir Robert Francis QC said:
In March, hospitals were asked to discharge patients with little or no notice and the speed with which this took place was important but led to mistakes. We do not want to detract from the heroic efforts of those on the frontline, who often put themselves at great risk to care for their patients, but services and system leaders have now had more time to prepare.
“It’s essential that we learn from what people have shared with us about the impact that a poorly-handled discharge can have on them and their loved ones. Taking action now will not only reduce the risk to patients but will also help improve the way people leave hospital in the future.”
British Red Cross Chief Executive Mike Adamson also said:
“As winter approaches and the pandemic continues, the British Red Cross is working alongside NHS and social care services to get people home safely from hospital. We’ve seen first-hand the huge efforts made to improve the discharge process for patients and their families. However, we also know despite good intentions and hard work, there are still barriers to making the ideals of discharge policy a reality.
“The Red Cross has been bearing witness to these issues for years, and we hope that the increased urgency of the situation will bring lasting change. Many of the people we support are older or more vulnerable, and fall into the higher-risk categories for Covid-19. Simple interventions, like getting equipment and medicine delivered, or follow-up visits, can make the difference between good recovery or someone regressing to the point of readmission - precisely at the time we want people to stay well, and stay at home.”
Read the report
Read the report to find out what people told us about their experience of hospital discharge during the pandemic.
