International Infection Control Week 2022: The impact of delayed discharge on hospital-acquired infections

At CHS Healthcare, we believe that improved patient flow is vital to the future of the NHS. The impact of delayed discharge on system efficiencies is well documented, but reducing unnecessary hospital stays also plays a vital role in tackling hospital acquired infections (HAIs).

A HAI is any infection —bacterial, viral, or fungal— that a patient did not have prior to arriving in the hospital and picks up during their stay. According to 2021 research, HAIs can be seen in 14.1% of delayed discharge cases [1]. As of November 2021, data even suggested that one in eight of all COVID-19 deaths in hospital were likely caused by hospital-acquired COVID-19 [2], and 2017 data found that an estimated 834,000 healthcare associated infections cost the NHS a total of £2.7 billion [3].

It makes sense that patients who remain in hospital for longer than needed are more susceptible to HAIs. Extending contact with different members of hospital staff multiple times a day, being moved to other wards, or being near to other patients and visitors, are all additional events that involve further exposure to potential infections. It’s not just infections that patients are more likely to acquire as a result of delayed discharge – patients can also see an increase in mortality, depression, dependency, as well as reduced mobility [4] [5].

Despite the evidence of the of delayed discharge on patient health, thousands of medically fit patients are stuck in hospital every day. According to NHS data from time of writing, 1 in 7 patients in hospitals are well enough for discharge [6] [7], suggesting that the current discharge planning model is broken. As we move into the winter season – traditionally the health service’s busiest period – swift action is needed to improve patient flow.

To unlock patient flow, the NHS needs to focus on:

• Collaborative planning – The current hospital discharge model is based on thirteen teams, working across primary, secondary, and social care. In this system, patients are passed along the chain with insufficient focus on case management from point of admission to discharge. We must improve how these teams work and plan together, ensuring more alignment and increased continuity of care through case management.
• Planning for discharge at an earlier stage – NHS Guidance states that discharge planning should start at admission but in many cases this process doesn’t start until a patient has nearly completed treatment or is fit to leave. We need to make sure that discharge planning is starting as early as possible to ensure efficient
• Improved digital infrastructure – Adopting innovative solutions that eliminate lengthy and unaligned processes, which ultimately result in staff loosing valuable time to otherwise avoidable or repetitive tasks.
• Family involvement – Actively engaging with families and next of kin throughout the entire process, to ensure that a patients’ needs and wants are involved in the planning for discharge.

By redesigning the hospital discharge system, NHS services can reduce pressure on staff and improve access to and quality of patient care, ultimately resulting in improved patient outcomes and lower levels of hospital acquired infections.

Contact us to find out how CHS Healthcare can help you to improve patient flow this winter and beyond: enquiries@chshealthcare.co.uk

Notes:

[1] BMC – Risk factors, costs and complications of delayed hospital discharge from internal medicine wards at a Canadian academic medical centre: retrospective cohort study: Risk factors, costs and complications of delayed hospital discharge from internal medicine wards at a Canadian academic medical centre: retrospective cohort study | BMC Health Services Research | Full Text (biomedcentral.com)

[2] The Telegraph – Exclusive: 11,600 people caught Covid in hospital and died: Exclusive: 11,600 people caught Covid in hospital and died (telegraph.co.uk)

[3] BMJ Open – Modelling the annual NHS costs and outcomes attributable to healthcare-associated infections in England: Modelling the annual NHS costs and outcomes attributable to healthcare-associated infections in England | BMJ Open

[4] National Library of Medicine – Impact and experiences of delayed discharge: A mixed-studies systematic review: Impact and experiences of delayed discharge: A mixed-studies systematic review – PubMed (nih.gov)

[5]. National Library of Medicine – Hospitalisation as a risk for functional decline in older adults:

[Hospitalisation as a risk for functional decline in older adults] – PubMed (nih.gov)

[6] NHS England – Hospital discharge data: Statistics » Hospital discharge data (england.nhs.uk)

[7] NHS England – Bed Availability and Occupancy: Statistics » Bed Availability and Occupancy (england.nhs.uk)