Delays in discharge from hospital of older people living with frailty
Research type
Research Study
Full title
Delays in discharge from hospital of older people living with frailty: what are the hidden challenges and how can they be addressed?
IRAS ID
244343
Contact name
Sabi Redwood
Contact email
Sponsor organisation
University of Bristol
Duration of Study in the UK
1 years, 1 months, 30 days
Research summary
Research Summary
This is an ethnographic study encompassing observations and interviews with staff, patients who are older and living with frailty and their carers that will be conducted across two sites; North Bristol NHS Trust and University Hospitals Birmingham NHS Foundation Trust.
There is evidence that some patients in NHS Hospitals are not always discharged from hospital when they and their doctors feel that they are well enough to return home. It is not always clear why this happens. The aim of this study is to find out what happens on hospital wards that may delay discharge.
The research team will recruit patients from each of the study sites as close to the time of admission as is feasible. The researchers will observe meetings related to the patient and access the patient’s medical notes to understand the obstacles and barriers that might influence the discharge process. Information collected from the observations and the medical notes will be written as field notes. The researchers will then interview the patients and their carers to explore their views and experiences of the discharge process 1-2 weeks after discharge.
The research team will also interview staff involved in the care of these patients to explore their views and experiences of the discharge process alongside shadowing and speaking to key members of staff involved in discharge planning to understand their contribution to organising discharges for frail older people.
The research team can then use the findings to identify the facilitators of effective hospital discharge that can be shared with health and social care teams and decision makers more widely on how to achieve best practice, reduce unnecessary costs and increase the benefits to patients in the NHS.Summary of Results
We worked with ward staff from two large NHS hospitals, and community and social care services staff. We observed the hospital stays of 37 patients over the age of 80 with moderate to severe frailty, and spoke to patients, family members and staff about their experiences.
We found that working practices in the hospitals may have inadvertently contributed to delays.
Different types of information about a patient were collected, recorded and accessed in different ways by different professionals. We called this ‘de-constructing’ the patient. For a patient to be discharged, all these pieces of information have to be found and put back together – or ‘re-constructed’. This can take time.
We found that information about a patient’s home life and how they were before their hospital stay was very important during the discharge process. We called this ‘Information About Me’.
Our findings have led to the following recommendations:Promote the metaphor of patient de-construction and re-construction among professionals to raise awareness of the key role of ‘Information About Me’
New electronic forms should avoid using standardised questions, to allow the patient’s personal story to be shared between staff in a narrative, rather than using tick boxes Work with patient and carer organisations to highlight the key role of ‘Information About Me’ to patients, families and carers Based on the research findings, we launched a campaign called Information About Me on 16 November 2020.
We created a short animation to raise awareness about what older patients and their family members can do to help patients be discharged from hospital when they are ready.
The animation links to an example of the information about older patients that clinicians need to help them make decisions about their safe and timely discharge from hospital.
We will be working closely with hospitals locally and nationally to introduce the use of Information About Me forms when an older person with frailty is admitted to hospital in an emergency.
As well as the Information About Me campaign, the findings from this study will help improve the process of discharging frail older patients from the participating hospitals. The findings will also provide valuable information for policymakers and healthcare professionals across the UK about how to reduce discharge delays for frail older patients.REC name
West Midlands - Coventry & Warwickshire Research Ethics Committee
REC reference
18/WM/0164
Date of REC Opinion
4 Jul 2018
REC opinion
Favourable Opinion