What we did
Part of the local Healthwatch programme is to carry out Enter and View Visits to health and social care services. The aim of these visits is to find out how services are being run and make recommendations where there are areas for improvement.
In 2010 Wandsworth Link visited St George’s to see how patients were experiencing being discharged from hospital. At the time some of the recommendations had not been accepted, and in the past year we became aware of various further concerns about the discharge process.
In April 2013 the Healthwatch Enter and View team undertook a follow up study to find out whether:
- Discharge is being planned effectively and sufficiently in advance.
- Carers and families are being adequately involved in discharge planning.
- Discharge Coordinators are sufficiently knowledgeable about social care assessment and the availability of community services.
- There is a clear procedure to ensure Discharge Coordinators identify and follow up within a few days of discharge those patients for whom such follow up is appropriate.
- Arrangements are in place to monitor and review the discharge process.
In order to do this we:
- Arranged visits to four wards to speak to staff and patients.
- Followed up the inpatients interviews by telephoning or visiting the patients after discharge.
- Analysed official data on delayed discharges and emergency re-admissions, and obtained analysis of patient concerns and complaints about discharges reported to St George’s.
- Approached local voluntary organisations to ask for evidence of good and bad patient experiences of leaving hospital.
There was some indication of efforts to improve discharge procedures, including a greater focus on monitoring discharge performance and better written information available for patients.
However, there remains a few problems yet to be resolved including:
- Most patients and families being confused about the role of the Discharge Coordinator.
- Transport delays.
- Lack of training amongst Discharge Coordinators.
- Patients being unaware of who they can contact post discharge if things go wrong and how to manage recovery from their illness.
- Endorse the importance of the Discharge Coordinator role and review how their time is prioritised, in particular to allow sufficient time for completing papers, researching base line pre-admission abilities and starting early discharge planning for all patients.
- Provide more training for Discharge Coordinators to include shadowing of more experienced staff and regular visits to community services to improve communication and knowledge.
- Acknowledge that many patients, particularly in the older persons’ wards, are unable to plan and anticipate their future needs without help.
- Planning requires time and skill to consult all parties, the patient, family/carers in order to make decisions in the patient’s best interest.
- Follow up more patients both to check their health and social care post discharge and as a form of audit of the discharge process.
- Work to develop channels of communication with outside agencies to improve the feedback of information to make the discharge process smoother and check what has worked well.
What happens next
Read St Georges Hospital response to our report.