Hospital discharge report

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.