Hospital discharge service requirements and provisions for care homes during the pandemic

In response to the Covid-19 pandemic, the Government has released a document setting out the Hospital Discharge Service requirements for all NHS Trusts, Community Interest Companies (CICs) and providers of acute, community beds and community health services staff in England. The requirements are applicable from 19 March 2020, onwards.

The purpose of these requirements is to ensure that only those patients who are required to be in hospital remain an inpatient, thus providing a greater number of beds for patients who attend hospitals with acute problems. It is expected that clinicians will only discharge those patients who they deem “clinically safe” to be discharged to less acute settings. The guidance provides a comprehensive series of questions for clinicians to use when assessing whether a patient is safe to be discharged. Annex B indicates a decision not to discharge is likely to be made in cases where patients:

• Require ITU or HDU care
• Require oxygen therapy/NIV
• Require intravenous fluids (where these cannot be provided in an alternative setting, i.e by community/district nurses)
• Have a NEWS 2>3
• Have a diminished level of consciousness where recovery is realistic
• Have acute functional impairment in excess of home/community care provision
• Are in the last hours of life
• Require intravenous medication >b.d (including analgesia)
• Have undergone lower limb surgery within 48hours
• Have undergone thorax-abdominal/pelvic surgery within 72 hours
• Have had an invasive procedure within the last 24 hours and have an attendant risk of acute life threatening deterioration.

All acute and community hospitals are required to keep a list of those suitable for discharge and provide a daily situation report containing the number and percentage of patients on the list who have left the hospital and the number of delayed discharges, if appropriate. Similarly, care homes and Community Rehabilitation Centres are required to keep a track of their capacity through the NHS North of England Commissioning Support Capacity Tracker tool.

There are 4 main pathways for discharging patients:

• Pathway 0 – it is estimated that 50% of patients will be discharged on this pathway which considers that they will require either minimal or no support once discharged home.
• Pathway 1 – it is estimated that 45% of patients will be discharged on this pathway which considers that they can be discharged home with support from health and/or social care providers.
• Pathway 2 – it is estimated that 4% of patients will be discharged on this pathway in which they require transfer for rehabilitation in a bedded setting – i.e. a community hospital.
• Pathway 3 – it is estimated that 1% of patients will have experienced a life changing event and therefore are unable to return home at the point of discharge from an acute hospital and will require nursing home care.

So what does this mean for patients? Within 1 hour of the decision being made to discharge the patient, the ward must escort them to a hospital discharge lounge so that their acute bed can be utilised as soon as possible. Within 2 hours, appointed discharge co-ordinators will arrange for patients to be transported home, or to a suitable rehabilitation bed or care home where applicable. Either on the day of discharge or the day after, the patient will be attended by a lead professional who will assess the level of care needs and arrange for support to be put in place if required.

Where a patient is being discharged to a care home but is unable to go to their first choice in the first instance, they will be discharged to an alternative care home with a transfer being made as soon as practicable. Where patients are discharged to community hospitals or rehabilitation centres, they must be continually assessed to determine whether they are able to be discharged home in order to ensure the continual flow of discharges through pathways.

Impact on care homes

The Government has promised to step up testing for coronavirus in care homes where symptoms of the virus have been found.

England’s care home regulator, the Care Quality Commission (CQC), already has to be notified when there is a death in a care home. From this week it will also ask care providers to give daily updates on deaths and the number of confirmed and suspected coronavirus cases.

The Government has also released £1.6bn of funding to local authorities – which are in charge of providing social care – with instructions that most of this should reach the adult social-care sector.”

For more information please refer to the Government’s published guidance which can be viewed here and here.