Implementing Delayed Discharges Recommendations

The HSE has established a Group to progress the implementation of the recommendations of the Report of the Independent Expert Review of Delayed Discharges.

The Group was established on foot of a request by Mr. Jim Daly, the Minister with responsibility for Mental Health and Older People.

The Group is co-chaired by officials representing the National Directors of Acute and Community Operations.

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The Department said the Group would identify changes that could be made within the first six months and those that could be implemented over eighteen months.
The Independent Expert Review of Delayed Discharges review recognised that delayed discharges or transfers of care were caused by a multitude of factors and it made nine recommendations which include the development of a national policy to provide for a more consistent approach to recording delayed discharges, strengthening data collection, standardising definitions.

It recommended:

  1. A national policy should be developed to provide a clear definition and guidelines for categorising DDs and replace the term “Delayed Discharge” by “Delayed Transfer of Care.”
  2. Steps should be taken to improve data quality and extend the DD dataset to non-acute healthcare settings and shift the focus of DD reporting to bed days lost and look at other methods of measuring the number of DDs e.g. those used in the Netherlands, England, and Scotland.
  3. A Joint Planning Forum between acute hospitals and community services should be set up to develop a shared view of demand and capacity needs and strategic responses to gaps in services.
  4. Roles and responsibilities should be reviewed, to assess the support for patients and their families on the NHSS process and clarify accountability lines of stakeholders responsible for managing DDs.
  5. An external data audit should be undertaken to review quality compliance, improve data quality and visibility and increase confidence in the data available.
  6. A public health campaign should be launched to raise awareness that patients who were discharged without delay had better outcomes and establish a consistent approach and timed pathway for communicating with families (next of kin) to minimise potential delays.
  7. Multi-disciplinary teams should be established to conduct single discharge assessments. These teams should be supported by staff both in the acute healthcare setting and in the community.
  8. Information sharing should be encouraged between Hospital Groups and CHOs on bed availability and patients’ status and an integrated ICT system, capturing supply and demand in both acute and non-acute healthcare settings should be established.
  9. Early discharge pathways to prevent admissions and reduce delayed discharges, should be established which in turn wouls enable assessment of care needs in the patient’s home or alternative care setting.

Minister Daly said, ‘’It is vital that we begin to address the underlying issues identified in the review and while I acknowledge change is difficult, these changes will lead to better and safer outcomes.’’

“We need to minimise the delays in moving patients to the most appropriate setting,  reduce hospital bed days lost and better address patient needs. Our ambition is to develop an efficient information-led service which caters to the real needs of patients. Illness
is a traumatic time for patients and families; they need certainty and best practice. This has the potential to really impact on our ongoing trolley difficulties by addressing our delayed discharges problem through simple good governance. A more efficient and knowledge-based health service will lead to better outcomes for patients.”