In new guidance published this month, the National Institute of Clinical Excellence (NICE) has recommended that hospitals appoint a ‘discharge co-ordinator’ – a health or social care practitioner who will be responsible for discharging patients in order to avoid discharge delays and, ultimately, free up more space in hospitals.
It is suggested that this could either involve the creation of a new role, or alternately, be an additional responsibility given to a member of the multidisciplinary team looking after a particular patient.
NICE have also recommended that discharge co-ordinators work to agree a discharge plan with the hospital and community-based teams and ensure that any specialist equipment and/or support required for patients is in place upon discharge.
This seems like a lot of additional work for healthcare professionals who are already members of multidisciplinary teams. It seems likely that lumping such a responsibility on top of somebody’s existing job role will lead to it simply becoming a tick-box exercise rather than an effective and comprehensive push to ensure that patients ready to be discharged are released quickly and with effective support in place to ensure they make a good recovery and avoid readmission to hospital. For these reasons, I would advocate the creation of a new role.
Whilst many will argue against spending on additional job roles at a time when the NHS is so strapped for cash, the costs of finding additional beds, and funding agency staff for patients who should already have been discharged surely more than offsets this, not to mention the costs of repeated admissions due to appropriate support packages not being in place upon discharge.
This recommendation seems to be a common sense suggestion to improve communication and co-ordination across healthcare providers and I am interested to see how many Trusts will invest in this suggestion and whether it will indeed produce longer term gains.
As we all know, winter is the time when hospitals, and in particular emergency care departments, are really tested. Many will recall the chaos of last winter when several hospitals were placed on black alert and ambulances were queued outside Accident & Emergency departments because no beds were available.
In addition to the ‘discharge co-ordinators’ mentioned above, other measures have also been announced to try to bridge the gap between discharge from hospital and recovery.
Chancellor of the Exchequer, George Osborne, announced in the recent autumn statement that council tax may be increased by up to 2 per cent in order to fund adult social care. The ‘Help Them Home’ report from the Royal Voluntary Service (RVS) revealed that family networks often struggle to support older people when they leave hospital. The report highlights the value of clinicians talking to patients’ families about their personal circumstances post-discharge and that better communication would lead to more appropriate care packages being put in place.
The RVS report identifies how in September 2015, there were 147,000 days of delay when patients who were clinically fit could have left hospital but didn’t due to delays in discharging them. The RVS also highlights, however, that there is a five-fold risk of readmission within three months when patients are discharged prematurely. The importance of a joined-up approach from the discharging hospital and social care agencies is therefore paramount.
Hopefully lessons have been learned from previous experience and hospitals and healthcare providers are now better equipped to deal effectively with the increase in demand for healthcare services this coming winter will undoubtedly bring.
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