Hospital discharge report

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Summary of report content

Healthwatch Staffordshire carried out a study into the experience of patients being discharged from hospital via discharge lounges. Local intelligence received from patients, their relatives and care home providers and national research reports indicated that hospital discharge, particularly for physically and mentally frail and unwell patients, often leads to poor experience if not planned and managed well. Local feedback indicated that the use of hospital discharge lounges as a means of discharging patients often resulted in long delays in discharge mainly due to waiting for medications, and/or transport. The purpose of this report is to give an overview of the findings of the discharge process at Staffordshire’s three acute hospitals (Royal Stoke Hospital, County Hospital Stafford and Queens Hospital Burton) and highlight some of the common issues identified and how these might be overcome to improve the patient experience. Individual reports with recommendations were produced for each hospital (not included in this report) and published on Healthwatch Staffordshire’s website. The study involved literature research to identify best practice use of discharge lounges and also five visits to the three acute hospitals for observation and interviews with patients and staff working on discharge lounges. These visits took place over three months in 2016. The key findings of the report related to delays caused by waiting for take-home medication, transport and writing-up of discharge summaries: - Pharmacy: The biggest area of concern identified at all three hospitals was the delay in obtaining take home medication for patients on the discharge lounges which can be very detrimental to a patient’s ‘wellbeing’. Delays in receiving medication led to delays in discharge. - Transport: Transport cannot be ordered until medication is delivered leading to further delays in discharge for those patients needing to use non-emergency ambulance services to get home. This could result in a further delay of 2 hours before transport arrives and then there is potentially some considerable time taken sitting on transport waiting for other patients on board to be dropped off first. - Discharge summaries and take-home medication: Ward Doctors were not always available to write up take home medication on the ward and have to be called to the discharge lounge to do this. This can lead to a further delay before medication can be ordered from the Pharmacy. The study also found: - all three discharge lounges were poorly signposted with no drop off/pick up points and parking was a significant problem - this could lead to delays in discharge as family members try to locate the lounge and search for a parking space; - the quality of the accommodation in the discharge lounges was poor – issues noted included cramped conditions, inadequate heating and air-conditioning and lack of privacy; - all staff working on discharge lounges were found to be enthusiastic and dedicated to making the patient experience as comfortable as possible; one aspect identified as impacting on their ability to deliver the best possible service was the impermanence of the location of the discharge lounge; - across all three sites, it was difficult to ascertain any criteria for how patients were selected to be discharged via the discharge lounges as opposed to discharge from the ward. There were no clear written criteria to establish patient’s suitability to go to the discharge lounge and no information is given to patients about what would be happening in the discharge process once a patient was admitted to the lounge. At two sites visited over two occasions, 4 patients appeared to be unsuitable for discharge via the discharge lounge. Each hospital produced individual action plans to address the issues raised and recommendations made in the individual Enter and View reports produced by Healthwatch Staffordshire. In this report the overall areas for improvement across all three hospitals were outlined as follows: 1) Operational guidelines: Clear operational guidelines would assist all staff involved in the successful discharge of patients to the discharge lounge. These should include clear criteria of patients unsuitable for transfer to the lounge. 2) Pharmacy: Patients should not have to wait more than 3 hours for medication as transport cannot be booked until medication is received. Staff training should include an understanding of the negative impact on patients of spending long periods of time in the discharge lounge. The whole pathway involved in the dispensing and delivery of medication should be reviewed. 3) Location: The discharge lounge should be in a permanent location and be fit for purpose. 4) Patient Information Leaflet: It would be helpful if patients were given a jargon-free leaflet that explained the discharge lounge and what they can expect during their time there. 5) Use of volunteers: Having volunteers sit and talk with patients whilst they are waiting would help take the pressure off permanent staff and enhance the quality of the service.

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General details

Report title 
Hospital discharge report
Local Healthwatch 
Healthwatch Staffordshire
Date of publication 
Wednesday, 12 July, 2017
Type of report 
Report
Key themes 
Building and facilities
Car parking access
Discharge
Information providing
Integration of services
Medication
Other
Prescription
Quality of care
Service delivery organisation and staffing
Healthwatch reference number 
Rep-1425

Methodology and approach

Was the work undertaken at the request of another organisation? 
No
What type of organisation requested the work 
N/A
If this work has been done in partnership, who is the partner? 
N/A
Primary research method used 
Observation
Structured interview
How was the information collected? 
Visit to provider
If an Enter and View methodology was applied, was the visit announced or unannounced? 
Not Known

Details of health and care services included in the report

Secondary care services 
Discharge lounge
Pharmacy
Other services 
Patient transport
Non-emergency ambulance service

Details of people who shared their views

Number of people who shared their views 
10
Age group 
Not known
Gender 
Not known
Ethnicity 
Not known
Sexual orientation 
Not known
Does the information include public's views? 
Yes
Does the information include carer's, friend's or relative's views? 
Yes
Does the information include staff's views? 
Yes
Types of health and care professionals engaged 
Administrative
All care professionals
Nurses
Does the information include other people's views? 
Yes
What was the main sentiment of the people who shared their views? 
Mixed

Outcomes and impact

Were recommendations made by local Healthwatch in the report? 
Yes
Does the information contain a response from a provider? 
No
Is there evidence of impact in the report? 
No
Is there evidence of impact external to the report? 
Yes
What type of impact was determined? 
Implied Impact

Network Impact
Relationships that exist locally, regionally, nationally have benefited from the work undertaken in the report
 
Implied Impact
Where it is implied that change may occur in the future as a result of Healthwatch work. This can be implied in a provider  response, press release or other source. Implied impact can become tangible impact once change has occurred.
 
Tangible Impact
There is evidence of change that can be directly attributed to Healthwatch work undertaken in the report.