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Length of admission and delayed discharge

 

We often hear concerns about lengthy hospital admissions and the negative effect this can have on an individual.

A lengthy period of time in hospital can undermine a person's confidence and independence and can help encourage an unnecessary dependency on others. We would expect that nursing staff would be able to give us details of cases of delayed discharge and the reasons for this.

We would expect that when someone's discharge is delayed that this is closely monitored to lessen the potential negative effect on them. On all wards we visited we asked about the average length of admission. Dementia assessment wards visited tended to have a longer average length of stay at 11 weeks compared with about 10 weeks for functional assessment and mixed dementia/functional assessment wards. There was however a wide variation with some wards reporting an average of only 4 weeks and some up to 24 weeks.

We also asked about the number of people whose discharge was delayed. By that we explained that we meant people who had been declared medically fit for discharge but who, for whatever reason, had not been discharged from the ward yet. (We should point out that the information on the number of delayed discharges we give is based on what the nurse in charge told us on the day of the visit and this may vary from statistical information provided by the individual NHS Board areas).

We found that the average number of people seen as delayed discharge on dementia assessment wards visited was 2.5 and 0.75 on functional assessment wards. The number for mixed functional and dementia assessment wards was 3.

We asked staff the reasons for these delays. We were told that across all wards the main delay was when people were waiting to move onto a care home but their first choice of care home was not currently available and they were waiting on the ward until they could move there.

We found that a large number of people were considered delayed discharge because there was a lack of an appropriate specialist care provider. This was usually a care home that was considered best able to look after people who had dementia but also some challenging behaviours. We also found that in dementia assessment wards, in around 1 in 10 people seen as delayed discharge were waiting to transfer to an NHS continuing care bed but none was currently available.

Both functional and dementia wards also had about one in ten people seen as delayed discharge because an application for a welfare guardianship order had been made but discharge could not happen until this was approved.