The British Red Cross look at variation between hospital discharges to home settings and the impact on recovery

policy digest

26 / 03 / 2019

Home to the unknown: Getting Hospital Discharge Right 
British Red Cross, March 2019

This report from the British Red Cross explores the experience of patients being discharged from hospital following unplanned stays. It focuses primarily on the experience of older people and seeks to examine how variances in care planning and discharge impacts recovery. Following this analysis the paper makes a number of recommendations for service and process improvement.
The paper identifies three key areas in a patient journey; in hospital care, discharge and recovery at home. It proceeds to outline challenges in these areas and how to overcome them.

Patient experience in hospital

The report finds that during their stay, some patients were not encouraged to take an active role in their own recovery while others were not given a clear indication of what was driving decisions over their discharge. One encouraging finding was that many patients found the ward to be a particularly social place and the regimen comforting. Another interesting finding was on perception of demand on NHS services, with the authors noting that one factor impacting patients’ experience in hospital or prior to being admitted was a desire not to ‘add to the burden’ on the health system. This resulted in some patients offering to drive themselves to hospital rather than be taken by ambulance or turning down care packages. While admirable in their intentions, the report notes that this attitude is problematic and should actively be challenged in order to ensure the best chance of recovery.

Discharge from hospital

Citing a number of areas that patients who were interviewed felt had caused them stress, the report highlights the emotional and financial impact that discharge can have on patients. This is compounded by unclear expectations on what exactly to expect in terms of outpatient care and who to expect it from. For many, a reliance on informal care and poor communication about other professional support available was a significant source of stress, negatively impacting their capacity to fully recover.

Recovery at home 

Tracing patients’ experience from before hospital, in hospital and post-discharge, the paper measures variation across five key independence factors; financial, practical, psychological, physical and social. The authors find that in most cases, specific and often preventable events bought about by a trust led to sharp and sustained deteriorations across 3 or more factors, although these deteriorations did level out or were occasionally reversed, there is a clear correlation between preventable incidents and a reduction in the independence and recovery of patients.

The authors make the following three recommendations, in the form of ‘ideal outcomes’ that patients should reasonably expect medical professionals to aim for in organising their care plan.

  1. Active consideration should be given to the implications for a patients long-term recovery when any any decision are made about their care during a hospital stay.
  2. Every patient should be helped to ‘thrive’ not just ‘cope’ after they are discharged from hospital.
  3. Empower patients to take a proactive role in self-care and self-management of their health.

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