Our Journey as a Pioneer in ‘Discharge to Assess’

Our Journey as a Pioneer in ‘Discharge to Assess’

Our Journey as a Pioneer in ‘Discharge to Assess’

Ever wondered how healthcare systems can balance patient safety and cost-effectiveness?

As one of the initial ‘Discharge to Assess’ providers, we’re proving it’s possible. Working closely with CCGs, Acute NHS Trusts, and Local Authorities, we’re pushing for an integrated service tailored to each local commissioner’s needs, with patient wellbeing and recovery as our focus.

It is well known that patients who stay in hospital when they are ready to be discharged are at higher risk of hospital-acquired infections and of losing mobility and independence. Delays in discharging patients also impact on the availability of hospital beds, leading to delays in ambulance handovers and in admitting patients from A&E.

The Health Foundation discusses the stark reality, pointing out the need for effective discharge partners such as us to carry out patient recovery at home.

-In December 2022, more than 13,000 beds – out of a total of around 100,000 hospital beds in England – were occupied by patients who were medically fit for discharge, an increase of 57% since December 2020. Although changes to the way data are collected make it difficult to compare with pre-pandemic data, the rate of growth over the last 2 years is unprecedented.

-This is not due to a slowdown in the rate at which patients are discharged – over the past year, the number of patients being discharged from hospital has increased by around 300 per day. However, the number of new patients who have been treated and are ready for discharge has increased by around 650 per day, explaining the increase in the number of patients medically fit for discharge who remain in hospital.

-The average wait between being deemed fit for discharge and actually being discharged was 1.3 days in December 2022. This average includes many patients who aren’t delayed at all; most delayed patients experience much longer discharge waits. This average masks significant regional variation: the average wait in the north west of England was 2.1 days, which was twice as long as in the east of England or London (1.0 day).

-Policy and media attention has often focused on social care as a key cause of the increase in discharge delays. Social care services are under huge pressure, and this is certainly contributing to problems with timely discharge. However, the percentage of patients experiencing delays who were waiting for social care services did not increase between February and December 2022, and was around 37% at the end of 2022.

-Although the percentage of delays due to patients waiting for social care services was increasing before the pandemic, it has never accounted for the majority of delays. Data collected just before the pandemic also show that, in February 2020, social care was recorded as solely or jointly responsible for 40% of delays, with the NHS solely responsible for the remaining 60%.

Our focus is alleviating delayed discharges and easing wider pressures on the health and care system. Hilton Nursing Partners are working with a number of NHS Trusts and councils to reduce the length of a hospital stay, delivering safe and timely hospital discharge support via our Home to Decide service.

Working with healthcare professionals, patients and their families, this nurse-led model of care and support is based at home, in familiar surroundings for 14 days of continual assessment and consultation, which includes advocacy, support, and recovery to independence.

By discharging patients as soon as clinically safe to their homes or communities, we’re not only ensuring their comfort but also contributing towards substantial savings in the healthcare system.