Minister for Mental Health and Older People Jim Daly today (Monday 19 November), announced the publication of the report of a Working Group set up to carry out an independent expert review of delayed discharges.
The review was established in recognition of the need to identify focused actions that will ensure that older people who are fit for discharge from hospital are supported to return to their homes and communities as early as possible.
Minister Daly thanked Mr Graham Knowles, Chairperson of the University of Limerick Hospital Group for chairing the review and acknowledged the commitment of the working group members.
The review recognised that delayed discharges or transfers of care are caused by a multitude of factors and it made nine recommendations which include the development of a national policy to provide for a more consistent approach to recording delayed discharges, strengthening data collection, standardising definitions and ensuring consistent discharge guidelines.
Minister Daly said
My immediate focus is on reducing delayed patient discharges and transfers of care as we come into winter through mobilising the additional resources being made available through the Winter Plan and ensuring that social care measures are effectively deployed to enable older people leave hospital and return to a more appropriate care setting, including their own home, as quickly as possible, with the supports they need.
The report underlines the importance of hospitals and communities working together to improve patient flow. This is in line with the overall direction of an integrated care approach, expanding community-based care to bring care closer to home, as outlined in Sláintecare. Minister Daly intends to analyse these matters further with the Department of Health and the HSE and outline a response to the report's recommendations over the coming weeks.
Welcoming the report, Minister Harris said
I recognise the need to focus on measures to target actions both in the immediate and longer term to ensure that older people are supported to leave hospital and return to their community. I have therefore, appointed Minister Daly to chair a working group to oversee progress on minimising the number of delayed discharges. Mr Daly will work with key agencies to reduce the number of delayed discharges as the health service enters this crucial phase of Winter.
Minister Harris added
The HSE has been allocated additional funding for the winter period for home care packages and other supports to minimise delays in people getting home from hospital, with a particular focus on those in the over 75 age group.
The report is available on the Department of Health website.
Notes to the Editor
Independent Expert Review of Delayed Discharges
A delayed discharge is a patient who has been deemed clinically fit for discharge from an acute bed, but whose discharge is delayed because he or she requires some form of ongoing support or care following their discharge and the support is not immediately available. Delayed discharges are a contributory factor to Emergency Department overcrowding and adversely affect patient flow throughout the hospital.
A Working Group was established by Jim Daly, Minister for Mental Health and Older People to carry out an independent expert review of Delayed Discharges (DDs) in June 2018. Graham Knowles, Chairperson of the University of Limerick Hospital Group, was appointed as Chair of the Working Group. The work of the review was undertaken from June to October 2018.
The overall purpose of the review was to identify changes that can be made in the short to medium term to minimise delays in patients returning home from hospital or to a more appropriate care setting, reduce hospital bed days lost to delayed discharges and to better address patient needs.
Summary of recommendations
1. Develop a national policy to provide a clear definition and guidelines for categorising DDs and replace the term “Delayed Discharge” by “Delayed Transfer of Care”;
2. Take steps to improve data quality and extend the DD dataset to non-acute healthcare settings and shift the focus of DD reporting to bed days lost and look at other methods of measuring the number of DDs e.g. Netherlands, England, and Scotland;
3. Set up a Joint Planning Forum between acute hospitals and community services to develop a shared view of demand and capacity needs and strategic responses to gaps in service;
4. Review roles and responsibilities to assess the support for patients and their families on the NHSS process and clarify accountability lines of stakeholders responsible for managing DDs;
5. Undertake an external data audit to review quality compliance, improve data quality and visibility and increase confidence in the data available;
6. Launch public health campaign to raise awareness that patients who are discharged without delay have better outcomes and establish a consistent approach and timed pathway for communicating with families (next of kin) to minimise potential delays;
7. Establish multi-disciplinary teams to conduct single discharge assessments. These teams should be supported by staff both in the acute healthcare setting and in the community;
8. Encourage information sharing between Hospital Groups and CHOs on bed availability and patients’ status and adopt an integrated ICT system, capturing supply and demand in both acute and non-acute healthcare settings.
9. Establish early discharge pathways to prevent admissions and reduce delayed discharges, which in turn will enable assessment of care needs in the patient’s home or alternative care setting.
Winter Plan 2018/19
The Department of Health is working closely with the HSE to ensure an appropriate response to the winter challenges to unscheduled care provision.
Additional funding has been allocated to the HSE for the winter period to help manage critical demand pressures, which lead to overcrowding in our hospital emergency department. The Minister for Health has asked the HSE to prioritise social care measures to enable patients to return home from hospital more quickly this winter, with a major focus on those in the over 75 age group.
It is expected that the Winter Plan will be published shortly.