Improve hospital discharge now before winter to manage second peak of COVID-19, warn Red Cross and Healthwatch England
However, the investigation did also uncover a number of positives including increased collaboration between services and positive feedback from the public for healthcare staff working under pressure.
Healthwatch England, with support from the British Red Cross and locally-based Healthwatch staff and volunteers, carried out work to better understand the impact of emergency measures implemented earlier this year to free up beds for COVID-19 patients.
More than 500 patients and carers (both paid and unpaid) across England took part in the survey, which gathered people’s experiences from late March to late August. Meanwhile, eight local Healthwatch and partners around the country carried out 61 in-depth interviews with key staff groups involved in the discharge process.
Key findings included:
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82% of respondents did not receive a follow-up visit and assessment at home, one of the key recommendations of the policy. Almost one in five (18%) of those also reported having unmet needs, such as equipment, medication or advice
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Some people felt their discharge was rushed, with around one in five (19%) feeling unprepared to leave hospital
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Over a third (35%) of respondents and their carers did not get a contact for further advice, despite this being a recommendation
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Overall patients and families were very positive about healthcare staff, praising their efforts during such a difficult time.
In addition, the research showed 30% of those who were tested for COVID-19 while in hospital did not receive their test results before they left. Not receiving test results before discharge into the community was raised as a barrier to ensuring people were able to manage their care safely after discharge. Staff highlighted that this was particularly problematic when patients were discharged to a care home given the heightened risk of transmission among residents.
As a result of these findings, recommendations from the two organisations ahead of winter to help manage a second wave of COVID-19 hospital admissions include:
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Post-discharge check-ins and assessments: services should ensure these take place as per guidance, whether by phone or in person.
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Discharge checklists: questions should include transport home, and equipment required.
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Communication: patients and carers should be assigned to a single point of contact for further support, in line with the national policy
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Medication: linking patients to voluntary sector partners who can deliver medicine could avoid discharge delays. Pharmacists should also be considered as part of multi-disciplinary teams supporting in the community
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Boost community care capacity and recognise value of the voluntary care sector in hospital discharge: the ‘discharge to assess’ model depends on follow-up assessments and care being available. Longer-term, more investment is needed to ensure this happens, including in the voluntary care sector
Sir Robert Francis QC, Chair of Healthwatch England, said: “In March, hospitals were asked to discharge patients with little or no notice and the speed with which this took place was important but led to mistakes. We do not want to detract from the heroic efforts of those on the frontline, who often put themselves at great risk to care for their patients, but services and system leaders have now had more time to prepare.
“It’s essential that we learn from what people have shared with us about the impact that a poorly-handled discharge can have on them and their loved ones. Taking action now will not only reduce the risk to patients but will also help improve the way people leave hospital in the future.”
British Red Cross and Healthwatch England’s findings and recommendations have been shared with the Department of Health and Social Care and NHS England/Improvement.
