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Delays in discharging elderly psychiatric in-patients

  • Irfan Hanif (a1) and Bhupendra Rathod (a2)
Abstract
Aims and Method

The issue of elderly psychiatric patients remaining in hospitals after being declared medically fit is of concern to doctors, hospital managers and politicians alike. This article sets out the findings from a study involving elderly psychiatric patients at a district general hospital, undertaken to establish the actual lengths, reasons for and financial implications of delays in discharge. The study involved 50 in-patients, all of whom had been discharged over the 3-month study period.

Results

More than half of the patients in the sample were subject to some delay in discharge and for patients waiting for Elderly Mentally Infirm (EMI) placements this averaged 50 days. Collectively, nearly 25% of the time spent in hospital was due to delay. The cost to the hospital was estimated at more than £700 000 in 1 year.

Clinical Implications

Patients are being put at extra risk in terms of their health by being delayed in hospital. Issues of institutionalisation, nosocomial infections and falls are of primary concern.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Angunawela, I. I., Barker, A. & Nicholson, S. D. (2000) The NHS and Community Care Act 1990. Impact of the discharge profile of patients with dementia. Psychiatric Bulletin, 24, 177178.
Epstein, J., Kaplan, G., Lavi, B., et al (2001) A description of inappropriate hospital stays in selected in-patient services: a study of cases receiving social work services. Social Work in Health Care, 32, 4366.
Lambourne, P., Ashaye, K. & Lambourne, A. (2005) The impact of delays in discharging patients. Health and Ageing, (1) 2528.
Lim, S. C., Doshi, V., Castasus, B., et al (2006) Factors causing delay in discharge of elderly patients in an acute care hospital. ANNALS Academy of Medicine Singapore, 35, 2732.
Murrison, A. (2002) Waiting Time for Discharge from Hospital. Parliament Publications. (http://www.publications.parliament.uk/pa/cm200102/cmhansrd/vo020212/debtext/20212-06.htm).
National Audit Office (2003) Ensuring the Effective Discharge of Older Patients from NHS Acute Hospitals. TSO (The Stationery Office).
Watts, R.V., Richold, P. & Berney, T. P. (2000) Delay in the discharge of psychiatric in-patients with learning disabilities. Psychiatric Bulletin, 24, 179181.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Delays in discharging elderly psychiatric in-patients

  • Irfan Hanif (a1) and Bhupendra Rathod (a2)
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eLetters

Delayed Discharges

Abigail J Trowbridge, ST1 Psychiatry
26 June 2008

We read the article by Hanif et al (Psychiatric Bulletin, June 2008, 32, 211-218) regarding delayed discharges with interest. At Mersey Care NHS Trust we are concerned about the proportion of Older People’s Mental Health beds that are blocked due to delayed discharges.

Between 1st April 2007 and 31st March 2008, there were 143 delayed discharges(48% of the trust total) with a mean length of 55 days. Therefore, 7865 ‘bed days’ were used by patients who no longer needed to be in hospital. The total cost of these delayed discharges was almost £2.1million (£265 per day).

The total number of inpatient days (April 2007-February 2008) was 28132, almost a third (28%) of which resulted from delayed discharges.

As the average length of inpatient stay was 57.2 days, the beds that were blocked by delayed discharges could have been used for 137 admissions.

Most (70.6%) of these delayed discharges were due to social reasons, such as waiting for a place in a care home.

It would probably be a more efficient use of resources if the money currently spent on delayed discharges was used to facilitate prompt discharges and appropriate aftercare arrangements.
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Conflict of interest: None Declared

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Delayed Discharges in Old Age Psychiatry

David C Tullett, Old age psychiatrist
26 June 2008

Dear Sir

Hanif et al (Psychiatic Bulletin, June 2008, 32, 211-3) describe the problems with delayed discharges which many elderly psychiatric wards are currently experiencing. It is interesting to note that mental health patients were initially included in the Community Care Act 2003. They wereonly excluded in a late House of Lords amendment after lobbying by mental health groups, particularly MIND.

As with 'New Ways of Working', we reap what we sow.

Dr David Tullett

Consultant Old Age Psychiatrist

Rochford Hospital, Union Lane, Rochford, Essex,

david.tullett@southessex-trust.nhs.uk
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Conflict of interest: None Declared

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