Government Pressures of reducing in-patient stay in NHS

  1. Can someone advice me here. I lead a speciality within this our turst. I am getting lots of pressure from management in implememting 10 high impact changes, in particular, gearing up more patient for day case or reducing the number of days patients spent as an in-pt. This means high effective & qualilty pre-assessment serivce.

    Which I feel we are nearly achieveing but at times community aspects lets us down (although i appreciate hard work they do). For e.g we refer our pts to social serivces as early as 2 months in advance so that they could initiate certain community packages in place and in time. However some local authority will not initiate until pt had a surgery. This is too late as most our pts only spent one or days in hosptial. So if they initiate service after the pts had surgery, this mean that pt ends up staying hosptial as long as a week.

    I will be raising this issuse with my manager but in a mean time any useful advice would be appriciated.
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  2. 10 Comments

  3. by   XB9S
    This is a really tough one as it is difficult to influence primary care services from acute care. You sound like you are having similar problems to most trusts which is frustrating. I work within a surgical speciality and find that the biggest factor in length of stay is community services.

    As for advise, go as high as you can to get changes made, yes deal with your manager but copy the more senior mangers and nurse directors in as well. Also sent copies of correspondence to the social service managers that you are finding causing delays.

    Not sure which are you work but I believe in England social services can get fined for delayed discharges, this doesn't happen in wales and we just have to put up with it.
  4. by   RGN1
    :yeahthat: There is definitely a fine for social services who delay patient discharges, I've even filled out the form a couple of times myself.

    We had a system of early identification of potential discharge problems & once nursing staff had completed the paperwork for such patients we had a discharge team in the hospital who then liased with social services etc to ensure that the discharge went ahead as planned, be it to home, nursing home or residential care. If the planned discharge was held up by social services & not through medical need then they were charged per day for each extra 24hr period that patient took up a bed they didn't need.

    Having said that you are right about it being very hard to be expected to cut down on patient stays without the staff in the community (or in the hospital to help nurse them back to health & give them advice before they go home). As usual you've been asked to do the impossible - save money without the staff or resources to do so!
  5. by   madwife2002
    The trouble as well is that discharges and SS always get worse in the winter months-not that it isnt always a problem
  6. by   karenG
    I work in primary care...........

    and communication with secondary is our biggest problem!! care packages can be put in place quickly but yes, Social services are a problem. I think a lot of it is down to budgets and how their money is allocated..

    our bug bear here is patients being discharged with no drugs...... just a letter saying please prescribe.. and then you cant read it!! if the drugs are new/ odd then it can take a community pharmacist a week to get the drugs... grrr so thats a pain for us out here..

    also.. why does it take months to get discharge letters??? its very difficult to provide continuity of care when you have no idea what happened to the patient........

    and it would be really nice if you could tell us when a patient dies............! even nicer if you could tell us why!

    Karen
  7. by   XB9S
    It must be terrible for your patients to be discharged without drugs, I can't imagine why any trust would allow this practice to happen . I know whereI work unless the patient discharges against medical advice then they are not allowed home without a take home prescription which includes a GP letter and discharge summary and explanation of any changes in medication.
  8. by   Silverdragon102
    Quote from XB9S
    It must be terrible for your patients to be discharged without drugs, I can't imagine why any trust would allow this practice to happen . I know whereI work unless the patient discharges against medical advice then they are not allowed home without a take home prescription which includes a GP letter and discharge summary and explanation of any changes in medication.

    I know my local hospitals only send patients home with a weeks worth of medication which isn't always enough time to get in to see a gp who can then make some amendments especially if they are discharged just before a weekend and a bank oliday follows. Although I work in a4 gp surgery we have had 1 on mat leave, holidays are still taken, all gp's wok 4 out of 5 days and another gp was off sick for a few weeks, very hard to get locum cover so appointments was very pushed for a while. NP did an excellant job and some stuff ended up being passed to the practice nurses which isn't in our normal scope but we just get on with it without putting license at risk. Thankfull a good gp to work for a good support but it is hard when patients get discharged and find it difficult to see anyone
  9. by   karenG
    Quote from XB9S
    It must be terrible for your patients to be discharged without drugs, I can't imagine why any trust would allow this practice to happen . I know whereI work unless the patient discharges against medical advice then they are not allowed home without a take home prescription which includes a GP letter and discharge summary and explanation of any changes in medication.

    its a cost thing........ if secondary care actually supply the drugs, it comes out of their budget.. if we do, it comes out of ours!! I suspect it will become more common as PCT tighten belts.. certainly in the PCTs here, patients are very lucky to come home with any drugs...which makes life hard when its not a common drug and so the pharmacy has to order it.. and the cost implications are huge (to us) because local pharmacys dont bulk buy or get any discount in the way a hospital can..

    Its a very short sighted way to work... and makes me mad because its not our fault....and patients get very upset when I say.. I'm sorry but I cant give you your tablets because I dont know what to give you! telling me its a pink tablet doesnt help!!!

    life is interesting out here in primary care!

    Karen
  10. by   english_nurse
    its definately a cost thing, when i first discharged patients into the community three years ago as a newly qualified nurse, patients went home usually with a box of each drug on their prescription chart, now they go home with exactly 7 days worth.
    communication is a major problem, i feel that area is really lacking, especially as nurses are short staffed on busy wards, sometimes the last thing on your mind is a discharge letter or phoning the district nurse even though it is essential to continue a patients care.
    another problem i have with discharge letters, the ones the doctors have to write, rather than the nursing ones is getting the doctors to actually write them, worse than getting blood from a stone sometimes
    with regards to speeding up discharges it all comes down to the eternal circle of money, time, space, money, no money for staff on wards, no time to write nursing assessment, no nursing homes as they are closing due to lack of money, no beds in hospitals (closed due to, guess what? money) nowhere for people to go that isnt hospital (no money for places like that) for example the last time i was at work there were two patients on my ward who were cases of self neglect who couldnt return to their homes for one reason or another, self caring, not ill, but stuck in hospital, recently one patient i had was waiting for a council flat (he had turned down 3 already, didnt like them) so stuck in hospital, the list goes on, and on,
    one thing i do find obstructive to patient discharges sometimes is relatives though, they dictate so much these days that it can make things very difficult,im not saying that they shouldnt have a say, but sometimes they need to be realistic. I once nursed a patient for just under a whole year! while his wife was obstructive in every way possible, wouldnt have him home, (just needed a bit of assistance, not particulary unwell) wouldnt let him go to certain residential homes because she would have to drive to see him, the only place she would allow him to go was in the village she lived in, fair enough, but the waiting list was huge, when we got him a place there she wouldnt pay the 25 per week top up fee he needed, she was working and assessed by social services as being able to afford this,
    anyway he died on my ward,:stone such a lovely man, but treated quite badly really.
    and the amount of people i have nursed who havent really been that ill but have been sent to hospital so their relatives can go on holiday, well, all i can say is these people shouldnt be in hospital, its not good for their health or good for the hospital, there should be proper support in the community, and more respite places available in my opinion.
    really the whole health service and community services is completly undersupported and underfunded, what on earth is going to happen in the future is anyones guess, but Government initiatives asking hospitals to speed things up are a bit insulting when half the reason behind all this chaos is sitting there before them each day when they look in the mirror!!


    blimy, moving house must have really stressed me out
    :imbar
    sorry am off my soapbox now
  11. by   ayla2004
    Quote from english_nurse
    its definately a cost thing, when i first discharged patients into the community three years ago as a newly qualified nurse, patients went home usually with a box of each drug on their prescription chart, now they go home with exactly 7 days worth.
    7 days i know a hospital that discharged on 3 days but it wad to a nursing home patient

    Quote from english_nurse
    one thing i do find obstructive to patient discharges sometimes is relatives though, they dictate so much these days that it can make things very difficult,im not saying that they shouldnt have a say, but sometimes they need to be realistic. I once nursed a patient for just under a whole year! while his wife was obstructive in every way possible, wouldnt have him home, (just needed a bit of assistance, not particulary unwell) wouldnt let him go to certain residential homes because she would have to drive to see him, the only place she would allow him to go was in the village she lived in, fair enough, but the waiting list was huge, when we got him a place there she wouldnt pay the 25 per week top up fee he needed, she was working and assessed by social services as being able to afford this,
    anyway he died on my ward,:stone such a lovely man, but treated quite badly really.
    and the amount of people i have nursed who havent really been that ill but have been sent to hospital so their relatives can go on holiday, well, all i can say is these people shouldnt be in hospital, its not good for their health or good for the hospital, there should be proper support in the community, and more respite places available in my opinion.
    Still a student had a placement on a very busy medical/COTE ward very often social needs when it came up to christmas the staff were geraing up for grandad dumping, one particlar lady used to dump her Learning Difficulties brother so she could avoid paying for respite care, she recieved an allowance to cover care. One stroke stable gentleman i asked the staff about i've been a care asaitant and we wseren't doing anything that couldn't be done in a NH, his sister has promised him no NH and was holdin up discharges by not looking for a place for him. Ah to those who now nurse outside the NHS/UK do u have these soical needs/abuses of the system. Other times i've worked with pt who are so lonely u wish u could help but an acute nhs ward is just not the place i wish i could. In first year my personal tutor told me patients feel more secure in nightngale(sp) wards rather than bays as they could see the nurse, my best experince was a COTE with a 7 pt bay i could see and they me all the pt but with a cmputer place to work and a shower room easy acess to the patients, everyone seemed to like it.
    :spin:
  12. by   english_nurse
    Quote from ayla2004
    7 days i know a hospital that discharged on 3 days but it wad to a nursing home patient



    Still a student had a placement on a very busy medical/COTE ward very often social needs when it came up to christmas the staff were geraing up for grandad dumping, one particlar lady used to dump her Learning Difficulties brother so she could avoid paying for respite care, she recieved an allowance to cover care. One stroke stable gentleman i asked the staff about i've been a care asaitant and we wseren't doing anything that couldn't be done in a NH, his sister has promised him no NH and was holdin up discharges by not looking for a place for him. Ah to those who now nurse outside the NHS/UK do u have these soical needs/abuses of the system. Other times i've worked with pt who are so lonely u wish u could help but an acute nhs ward is just not the place i wish i could. In first year my personal tutor told me patients feel more secure in nightngale(sp) wards rather than bays as they could see the nurse, my best experince was a COTE with a 7 pt bay i could see and they me all the pt but with a cmputer place to work and a shower room easy acess to the patients, everyone seemed to like it.
    :spin:
    i forgot to mention the dumping that happens it awful

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