Hospital Discharge

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Acknowledgements We are, first and foremost, indebted to the patients and carers who shared their experiences of hospital discharge at Broomfield Hospital. Their stories offer rare and invaluable insight into where improvements can be made and we hope other patients and carers will benefit from them. We are also very grateful to the ward and discharge team staff for sharing their insight into the discharge process honestly and articulately in interviews, and to the whole discharge team for letting themselves be observed for the purposes of uncovering good discharge practice and areas for improvement. Our thanks go to hospital Medical Director, Dr Ronan Fenton, and Acting Chief Nurse, Lyn Hinton, for helping to facilitate access to the hospital and receiving the findings proactively and with enthusiasm. Also we would like to express our thanks to Professor Justin Waring and Dr. Simon Bishop from Nottingham University Business School for their advice during the design and planning stages of the study. We would also like to acknowledge other Healthwatch Essex staff; Dr Ofra Koffman who put together the successful ethics application, Sarah Haines who uncovered local and national information providing important context for the study, and Dr Tom Nutt, Chief Executive Officer of Healthwatch Essex, for his guidance and support. Finally, this ambitious piece of research would not have been possible without the dedication and enthusiasm of Healthwatch Essex Ambassadors, Janet Tarbun and Lauraine George, who offered their time for free to administer surveys in the discharge lounge. Report authors Dr Oonagh Corrigan Research and Commissioning Manager, Healthwatch Essex and Visiting Fellow, School of Health and Human Sciences, University of Essex Dr Alexandros Georgiadis Research Associate, Healthwatch Essex Abbi Davies Research Assistant, Healthwatch Essex Dr Pauline Lane Senior Research Associate, Healthwatch Essex and Reader in Mental Health, Anglia Ruskin University Emma Milne Research Associate, Healthwatch Essex Dr Ewen Speed Senior Lecturer, Medical Sociology, School of Health and Human Sciences, University of Essex Duncan Wood Research Consultant, and Director of Research for Communities Abbreviations CCG Clinical Commissioning Group NRES National Research Ethics Services CHC Continuing Healthcare OT Occupational Therapist DST Decision Support Tool PALS Patient Advice and Liaison Service EoL End of Life Care SW Social Worker HWE Healthwatch Essex TTA ‘To Take Away’ (referring to medicinal tablets) NHS National Health Service TTO ‘To Take Out’ (referring to medicinal tablets)
Contents 1. Insights into Hospital Discharge 2 2. Healthwatch Essex 3 3. Background 4 3.1 Hospital discharge: an issue of national concern 4 3.2 Continuity of care 5 3.3 A growing, elderly, frail population 5 3.4 Hospital resources 5 3.5 Hospital discharge in Essex 6 3.6 Broomfield Hospital 7 3.7 Study design 7 3.8 Previous research and stakeholder views 7 3.9 Study aims 8 3.10 Ethics 8 4. Methods 9 4.1 What data did we collect? 13 5. Lens 1 Patient survey in discharge lounge 14 5.1 Discharge lounge use 14 5.2 Delays 14 5.3 Involvement in decision to discharge 15 5.4 Information and communication 16 5.5 Transitional care 17 5.6 Lens 1 summary of survey findings 17 6. Lens 2 Patients recruited from wards 18 6.1 Information and communication 19 6.2 Involvement in discharge planning 20 6.3 Early discharge and transitional care 21 6.4 Lens 2 summary of patient diaries and interviews 23 7. Lens 3 Staff 24 7.1 Ward staff 24 7.1.1 Shortage of key staff 24 7.1.2 Lack of resources for fast track 25 7.1.3 Co-ordinating care 26 7.1.4 Information, communication and processes 26 7.1.5 Challenges with families 27 7.2 Discharge team staff 28 7.2.1 Resource challenges 29 7.2.2 Poor communication and disputes between hospital staff 31 7.2.3 Managing relationships with patients and families 35 7.3 Lens 3 data summary 36 8. Conclusion and recommendations 37 8.1 Concluding discussion 37 8.1.1 Involvement in discharge planning 38 8.1.2 Communication and information 38 8.1.3 Patients as active agents in their care 38 8.1.4 Lack of integrated care 39 8.1.5 Staff and patient expectations 39 8.2 Recommendations 40 8.2.1 Information and communication: patient, carer and hospital staff 40 8.2.2 Information and communication: discharge and ward staff 41 8.2.3 Provision of integrated care 41 8.2.4 Education and training 41 8.2.5 Pharmacy and transport 41 9. Bibliography 42 List of figures and tables Figure 1: Three Lenses approach 10 Figure 2: Discharge description 15 Figure 3: Reasons for delay 15 Figure 4: Availability of discharge plan 16 Table 1: Patient profiles for Danbury and Rayne wards 19 1
Page 1: Essex Insights into Hospital Discha
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Hospital Discharge

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