Hospital patients will in future no longer be able to pick and choose where they move to after they have recovered, a Government minister has warned.
A Department of Health audit shows more than 50 per cent of patients in some areas are refusing to leave hospitals for transitional care, even though they are well enough to be discharged, because they are unwilling to go to the particular facility offered to them.
Minister of State at the Department of Health Jim Daly, in response to the audit’s findings, said hospital patients and their families will have to come to terms with being transferred to more appropriate step-down care facilities as prescribed by doctors.
“Refusing to transfer will have to be clamped down on,” he said. “Everyone lying on an acute hospital bed who does not need to be there, is taking up the place of someone who does, and this is contributing to higher trolley figures.”
One measure being examined would require patients to agree care plans with doctors, including discharge options, at the time they are admitted.
About 620 patients are currently languishing in hospital, despite being better, while their discharge is being organised. More than half of these delayed discharges are waiting on a nursing home place but others require step-down care.
The Health Service Executive (HSE) has on occasion been forced to take expensive and lengthy legal proceedings to force out patients who were needlessly occupying a hospital bed.
Ongoing support
Mr Daly said hospital overcrowding could be reduced through better governance of delayed discharges. These occur when a patient has been deemed clinically fit for discharge from a hospital bed, but has to remain as they require some form of ongoing support or care, which is not immediately available.
The Minister has established an implementation group to make changes to the existing system for dealing with delayed discharges both in the short term (over six months) and over an 18-month period.
The take-up rate for transitional care, available to patients who are ready for discharge from acute care, is often lower than it should be, he said.
“While there will always be extenuating circumstances that may prevent the transfer of a small number of patients, the current figures are far too high and patients must accept the most appropriate care provided by the health services, in the most appropriate care settings,” Mr Daly said.
“Taking up a bed in an acute hospital when one doesn’t need to be there, simply because one doesn’t want to go to a community hospital 30 or 40 minutes down the road where adequate care is available, is not good enough. As this practice is permitted to continue, more seriously-ill patients in need of acute care are on trolleys waiting to get in.”
The new implementation group will ensure patients and families engage in post-hospital care placement in a timely manner, he added.
The Department of Health is to ensure a national policy is established and the HSE will seek to implement this consistently.
The HSE has also been told to develop better communications regarding delayed discharges to ensure patients and families understand that discharge from hospital is better than being kept unnecessarily in an acute health-care setting.
A key objective will be to ensure the length of assessment for those who are leaving hospital should not exceed six weeks.
