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Delayed discharge from intellectual disability in-patient units

  • John Devapriam (a1), Satheesh Gangadharan (a1), Judith Pither (a1) and Matthew Critchfield (a1)
Abstract
Aims and method

We undertook a cross-sectional service evaluation of the reasons and extent of delay in the discharge process in an intellectual disability hospital over a 12-month period. Delays at each stage of the discharge process are also quantified in this study.

Results

We found that discharge was delayed for 29% of patients during the study period. The majority (78.5%) was due to awaiting completion of assessment of future care needs and waiting for public funding.

Clinical implications

Commissioners (health and social), provider trusts, regulators and community providers should consider the reasons for delay in the discharge process and adopt a whole systems approach to discharge planning. This is highly relevant in light of recommendations by the Department of Health following the Winterbourne View scandal, which has raised concern about patients staying in intellectual disability in-patient units too long and for the wrong reasons.

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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.
Corresponding author
John Devapriam (john.devapriam@leicspart.nhs.uk)
Footnotes
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© 2014 The Royal College of Psychiatrists. This is an open-access article published by the Royal College of Psychiatrists and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Declaration of interest

None.

Footnotes
References
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1 Bryan, K, Gage, H, Gilbert, K. Delayed transfers of older people from hospital: causes and policy implications. Health Policy 2006; 76: 194201.
2 House of Commons Health Select Committee. Delayed Discharges (Third Report of Session 2001–02). TSO (The Stationery Office), 2002.
3 Department of Health. Discharge from Hospital: Pathway, Process and Practice. Department of Health, 2003.
4 Watts, RV, Richold, P, Berney, TP. Delay in the discharge of psychiatric in-patients with learning disabilities. Psychiatr Bull 2000; 24: 179–81.
5 Dickinson, MJ, Singh, I. Mental handicap and the new long stay. Psychiatr Bull 1991; 15: 334–5.
6 Perera, C, Simpson, N, Douds, F, Campbell, M. A survey of learning disability in-patient services in Scotland in 2007. J Intellect Disabil 2009; 13: 161–71.
7 Patterson, T, Higgins, M, Dyck, DJ. A collaborative approach to reduce hospitalisation of developmentally disabled clients with mental illness. Psychiatr Serv 1995; 46: 243–7.
8 Healthcare Commission. A Life Like No Other: A National Audit of Specialist Inpatient Healthcare Services for People with Learning Difficulties in England. Healthcare Commission, 2007.
9 Department of Health. Department of Health Review: Winterbourne View Hospital (Interim Report). Department of Health, 2012.
10 Department of Health. Transforming Care: A National Response to Winterbourne View Hospital. Department of Health Review: Final Report. Department of Health, 2012.
11 NHS Confederation. Papering Over the Cracks: The Impact of Social Care Funding on the NHS. NHS Confederation, 2012.
12 Royal College of Psychiatrists' Faculty of Psychiatry of Intellectual Disability. People with Learning Disability and Mental Health, Behavioural or Forensic Problems: The Role of In-Patient Services (Faculty Report FR/ID/03). Royal College of Psychiatrists, 2013.
13 Department of Health. Decision Support Tool for NHS Continuing Healthcare (Revised). Department of Health, 2012.
14 Department of Health. SITREPS 2003–2004 Final Version Definitions and Guidance. Department of Health, 2003.
15 Department of Health. National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care. Department of Health, 2012.
16 Personal Social Services Research Unit. Delayed Discharges from Hospital (Discussion Paper M197). PSSRU, 2007.
17 BBC One Panorama. Undercover Care: The Abuse Exposed. BBC, 2011. Available at http://www.bbc.co.uk/programmes/b011pwt6.
18 Cumella, S, Marston, G, Roy, A. Bed blockage in an acute admission service for people with a learning disability. Br J Learn Disabil 1998; 26: 118–21.
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BJPsych Bulletin
  • ISSN: 2053-4868
  • EISSN: 2053-4876
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Delayed discharge from intellectual disability in-patient units

  • John Devapriam (a1), Satheesh Gangadharan (a1), Judith Pither (a1) and Matthew Critchfield (a1)
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