What was leaving hospital like?

Healthwatch Kingston wanted to gather feedback from patients about their experiences of discharge from Kingston Hospital, particularly with respect to communications during the discharge process. They were interested in what was working well and what might be done to improve patient experience of the discharge process. Healthwatch Kingston was also interested to find out if experiences varied at different points in the year and also if there was any difference between patients who had a planned (elective) or unplanned (nonelective) stay in hospital.

The surveys were distributed in paper form (with the option to complete online) to all 14 wards in Kingston Hospital across two periods

• 12th November to 6th December 2018
• 4th March 2019 to 31st March 2019

A total of 183 surveys were returned (93 surveys in November/December and 90 surveys in March). Of the 183 total respondents, 83 said they had an unplanned stay compared with 96 who said they had a planned stay. Four did not specify.  In the event there was no real difference in responses between the two phases.

Findings

• Overall 59% of respondents said that they were given an estimated time for discharge at least 24 hours before they were due to leave. There were a higher proportion of people who had had a planned stay compared to an unplanned stay in this group.
• 88.5% felt sufficiently involved in the preparation of their discharge. There were a higher proportion of people who had had a planned stay compared to an unplanned stay in this group.
• over half (57.3% said that there was no delay when leaving the hospital. There was however, a significant difference in the experience of patients who had a planned stay compared to those with an unplanned stay, with 74.7% of planned patients reporting no delay compared with only 37% of unplanned patients.
• The most common reason for delays in discharge was waiting for medication at 31.9%. This was followed by patients waiting for their discharge letters at 24.7%, then waiting for transport at 13.4%.
• 82.7% were given written or printed information about what they should or should not do after leaving. However, 91% of planned patients said they were given materials compared with only 73.7% of unplanned patients.
• Only 1.4% of people said that the information provided to them at discharge was unhelpful.
• Of the 17 people who needed information in a different format, only 3 were given it.
• 94.8% said they knew what would happen with their care after discharge from Kingston Hospital.
• 51% [said that if arrangements were made for them to be visited by a health professional after leaving hospital, that these arrangements worked well. However, 39% said that they did not work well. There was also a difference in the experience of planned and unplanned patients with 50% of unplanned patients saying the arrangements did not work well compared with 20% in the planned category.

Recommendations

• the Trust should explore how to ensure all patients, whether in Kingston Hospital for a planned or unplanned stay, are given an estimated time for discharge at least 24 hours before they are due to leave.
• the Trust should explore ways to further improve staff communication so that all patients, those that help them at home (for example a friend or carer) and particularly people who have had unplanned stays in Kingston Hospital, feel more involved in the preparation of their discharge.
• the Trust should introduce ways to further reduce delays when leaving Kingston Hospital, in order that patients with either planned or unplanned stays in hospital are provided for equitably.
• the Trust should consider providing more realistic discharge times to manage patient, family, friend and carer expectations
• the Trust should provide all patients with printed information about what to do after they leave Kingston Hospital (regardless of whether patients are being discharged from planned or unplanned stays).
• the Trust should consider improving the information given to them at discharge so that it is more detailed and uses less medical jargon.  It should also consider how this information might be provided digitally.
• the Trust should explore ways to ensure discharge information is provided in accessible and alternative formats for disabled people, particularly where staff are discharging people living with a learning disability, autism and other neurodiverse conditions.
• the Trust and Community Care Providers should explore ways to ensure that appropriate, ‘joined-up’ follow-up care in the community is provided to patients requiring it after they have been discharged from Kingston Hospital.