Delayed discharge policy could create readmissions, NHS watchdog warns

Emergency hospital readmissions of older people have gone up as
delayed discharge rates have fallen, raising concerns some patients
are being discharged too quickly, writes Craig
Kenny.

The Healthcare Commission’s annual State of Healthcare Report
finds that while the proportion of delayed discharges among
over-75s almost halved between September 2001 and March 2003 from
12 to 6.5 per cent, the proportion needing emergency readmission
within 28 days rose from 7.1 to 8.2 per cent over the same
period.

“Older people must not be rushed back into independent living
before they are ready,” the report warns. “If they are,
there may be a greater risk they will quickly need to be readmitted
to hospital. There is some evidence that this may be happening with
increasing frequency.”

The figures follow earlier concerns that pressure on health and
social services departments to free up beds quicker could encourage
doctors to discharge patients from hospital before they are fully
ready.

Under the government’s delayed discharge reimbursement
system, which came into force in January, social services
departments can now be fined £100 (£120 in London and the
south east) per day for any patient not given a care package within
three days of discharge notification.

The report reveals that the percentage of patients aged over 75
whose discharge was delayed in each of the 28 strategic health
authorities varied from 3.2 to 15.4 per cent in England in the year
to March 2003. The highest rates were in southern English counties
such as Hampshire, Surrey and Sussex, where high property prices
squeeze out residential care, the report states.

Hospital staff should discuss home care arrangements with older
patients before discharging them, adds the report, highlighting
that this did not happen in almost one quarter of cases.