There was an average of 100 people a day stuck in hospitals overnight in Northern Lincolnshire and Goole NHS Foundation Trust (NLAG) in October who didn’t need to be there.
NLAG’s chief operating officer has said staff are working “incredibly hard” to get patients fit to leave hospital out, but this is not always possible. Improvements have been made though to speed up discharges, including consultant ward rounds at weekends and a seven-day escalation process to address issues causing delayed discharge.
The latest monthly figures published last week by NHS England indicate the level of bed-blocking in the region, where patients which medically could be discharged cannot be.
This amounted to an average of 100 patients each night who could have been discharged but NLAG hospitals were unable to. There were also 506 additional bed days of patients who had stayed seven plus days in hospital in the week starting October 24, and 354 additional bed days of patients who had been in hospital for three weeks or more. These are measured weekly on a daily snapshot basis.
In September, the average number of patients bed-blocking overnight was 104, and six months ago the figure was even higher, at 133 for April. “Our staff are working incredibly hard to get patients who are fit to leave hospital home as soon as possible,” said Shaun Stacey, NLAG’s chief operating officer.
“However, despite our best efforts, there will always be reasons why some patients are unable to be discharged. Nobody wants to be in hospital for longer than they have to be, but a significant challenge facing hospitals and health care systems across the country is getting people back to where they call home in a timely way, once they’re fit to leave the ward.”
He said that NLAG has been working on improvements to the discharge process, not just at hospital level but also with community services and social care partners so it is a “whole system approach”. “As part of our ongoing learning, we have run a programme called the Perfect Fortnight, which has, in principle, enabled us as a system to reinforce the best practice around discharge and discharge management, and make early clinical decisions about getting people home when they are ready.
“We have also seen some further success in our performance. For the week ending 30 September, we had 48 patients delayed. For the week ending 18 November, we had 31 patients delayed.”
He also highlighted actions taken to speed up and improve the process, including:
- Weekend consultant ward rounds
- Move to a fully electronic handover system
- Creation of a seven day escalation process to address elements delaying discharge
- Two integrated hospital discharge hubs, one each for North and North East Lincolnshire
The trust has also brought in an acute frailty assessment service and introduced a seven day Same Day Emergency Care (SDEC) ward. “Work has been undertaken to ensure patients who require support on discharge are supported by the most relevant team in a timely manner, ensuring they have timely access to the services they require to enable them to leave a hospital bed,” Mr Stacey said.
“The use of voluntary sector organisations has also been increased to support timely discharge. Our Single Point of Access (SPA) teams are working with East Midlands Ambulance Service (EMAS) and Yorkshire Ambulance Service (YAS) with the management of patients who have requested an ambulance but where hospital admission is not necessary.
“We are reducing hospital admission. In North Lincolnshire, our SPA GP is working with residential care homes, nursing homes and domiciliary care agencies in helping to avoid unnecessary hospital admissions for patients they are caring for.”
Mr Stacey previously reiterated three weeks ago NLAG’s message to people seeking non-urgent care or unsure if they need more urgent care in northern Lincolnshire to avoid going to A&E as their first port of call. Instead, the advice is to call 111, see a GP, go to the local pharmacy or even with minor colds, simply stay at home. While he stressed everyone who goes to A&E will eventually be seen, he warned of very long wait times and that emergency departments were “struggling but coping”.
Slow ambulance to hospital handover times was identified earlier this week by the head of operations at East Midlands Ambulance Service (EMAS) as a major factor behind missed ambulance response targets. EMAS lost an estimated 13,000 resource hours in August due to handover with hospitals delays.
It is asking patients who are requested by call handlers to make their own way to hospital to try to do so, to relieve pressure. The average wait time for Category 1 incidents in October in the East Midlands, which includes northern Lincolnshire, was nine minutes and 38 seconds. Category 1 incidents cover life-threatening injuries and illnesses, including cardiac arrest.
The problem of patient discharge is being experienced across the country, though figures for United Lincolnshire Hospitals Trust were not available at the time of publishing.
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