Objective: To investigate the extent of, and factors contributing to, delayed discharges for younger adults in rehabilitation.
Method: Survey of patients discharged and awaiting discharge in a six-month period in five centres across England operated by a leading independent sector provider. Discharge was classified as delayed if a person had been waiting more than 30 days for transfer.
Results: One in three beds was occupied by a delayed discharge (median delay > seven months). Common reasons were absence of a suitable placement (41%) and failure to obtain funding for postdischarge support (31%). Delays were also associated with poor indoor mobility and additional physical/mental health problems. We estimated earlier discharge would have resulted in overall cost savings of almost £490 000.
Conclusion: Delayed discharge remains a significant obstacle to the development of cost-effective care pathways for younger adults. Our study suggests that health and social services are not exploiting the UK government's legislation for flexible partnership working in this area.
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References
1.
1 National Audit Office. Inpatient admissions and bed management in NHS acute hospitals. TSO, 2000.
2.
2 Audit Commission. Bed management: review of national findings. Audit Commission, 2003.
3.
3 Carter ND, Wade DT. Delayed discharges from Oxford city hospitals: who and why?Clin Rehabil2002; 16: 315-320.
4.
4 Lelliott P, Wing J, Clifford P. A national audit of new long-stay psychiatric patients II: impact on services. Br J Psychiatry1994; 165: 170-178.
5.
5 Shepherd G, Beardsmoore A, Moore C, Hardy P, Muijen M. Relation between bed use, social deprivation, and overall bed availability in acute adult psychiatric units, and alternative residential options: a cross-sectional survey, one-day census data, and staff interviews. BMJ1997; 314: 262-266.
6.
6 Department of Health. NHS responsibilities for meeting continuing health care needs. 1995; HSG (95) 8, LAC (95) 5.
7.
7 Glasby J, Littlechild R. The health and social care divide. Pepar Publications, 2000.
8.
8 Wood RLl, Worthington AD. Neurobehavioural rehabilitation: a conceptual paradigm. In Wood RLl, McMillan TM eds. Neurobehavioural disability and social handicap following traumatic brain injury. Psychology Press, 2001: 107-131.
9.
9 Mohammed A, Thomas BM, Hullin MG, McCreath SW. Audit of orthopaedic bed utilisation. Health Bull2001; 59: 353-355.
10.
10 Vetter N. Inappropriately delayed discharge from hospital: What do we know?BMJ2003; 326: 927-928.
11.
11 Department of Health. Medical stability and ‘safe to transfer’. Health and Social Care Change Agent Team/Reimbursement Implementation Team. Department of Health, 2003. Accessed 13 January 2005 from www.dh.gov.uk/PublicationsAndStatistics
12.
12 Glasby J. Hospital discharge. Integrating health and social care. Radcliffe Medical Press, 2003.
13.
13 Koffman J, Fulop N, Hudson M. Assessing the impact of delayed discharge on acute care. Nurs Stand1996; 10:41-43.
14.
14 Kutiyanawala MA, Pickering S, Everson NW, Hemingway D, Watkin D. An audit of bed usage in an acute surgical ward: are we managing our resources effectively?Ann R Coll Surg Engl (Suppl)1998; 80: 223-224.
15.
15 Nocon A, Baldwin S. Trends in rehabilitation policy: areview of the literature. King's Fund, 1998.
16.
16 Sinclair A, Dickenson E. Effective practice in rehabilitation: evidence from systematic reviews. King's Fund, 1998.
17.
17 South J. Eligibility criteria and entitlements: defining need for NHS continuing care. Soc Pol Admin1999; 33: 132-149.
18.
18 Department of Health. Changing places. Report on the work of the Health and Social Care Change Agent Team 2002/03. Department of Health, 2003.
