Delayed transfers from hospital: are there solutions?

Prolonged stays in hospital are inconvenient, costly for the hospital and there is evidence that it may have negative effects on patients. Delayed transfers of care out of hospital, and to a place where patient’s care needs can be met, is fraught with difficulty, as well as impacting on the flow of patients into the hospitals. Too many people experience unnecessary delays in discharge. Nearly 350,000 patients spend more than three weeks in acute hospital beds, each year. 

Many of those people are older patients and also frail. Their stay in hospital can increase their frailty, increase the likelihood of them getting an infection and reduce their mobility. A reduced length of stay is important for their well being and maintaining independence. However, this is not the experience of many patients. The unfortunate term of ‘bed- blocking’ has been used in the NHS for many years, but is considered to be a derogatory term. Under recent situations, both within the health service and in social care, delayed discharges have not reduced as much as was hoped, putting extreme pressure on hospital bed availability – especially under recent winter pressures. 

So, what are the main reasons for delays to discharge? To date there is a scarcity of research related to delayed discharges, but the challenges are identified as: suitable discharge destinations, capacity of future support to meet their needs, and lack of supply of social care. In addition, waiting for post-hospital care packages accounts for a large proportion of reasons for delays.1 The main reasons for delay identified in NHS Statistics2 are: awaiting care packages in own home; awaiting nursing home placements and waits for residential home placements; as well as awaiting community equipment and adaptations. The incidence of delayed discharges is compounded by the lack of community beds due to the closure of nursing homes and community hospitals in England.