In an integrated health and care system that is working effectively, patient transition between acute hospital-based care and community or primary care is smooth and well-coordinated. The system would ensure that patients are discharged from hospital in a timely fashion and the appropriate primary or community services are in place, so care is uninterrupted. The survey included a number of questions on the discharge process and the information provided, as well as the support received after leaving hospital.
Results show that experiences of discharge were less positive than other aspects of patients’ stay in hospital. Significant minorities reported that their home situation was not taken into account when leaving hospital, they were not given information on who to contact should they become worried, and they were not given information on the medicine they needed to take. Similarly, around one in four said that they did not receive the post-discharge care and support they felt would have been useful. Across every one of these measures, COVID-19 patients reported poorer experiences.
A report by Healthwatch England and The British Red Cross looked at hospital discharge experiences during the pandemic. They concluded that while patients expressed gratitude for staff, one in five felt unprepared to leave hospital. The report found 82% of patients did not receive a follow-up visit and assessment at home.
Discharge should be included as part of a patient’s treatment plan, in full agreement with the medical team and should be planned as early as possible. NICE recommends that medical teams start planning a patient’s discharge at the time of admission.
Results show that 59% of patients diagnosed with COVID-19 felt their family or home situation, including the risks that COVID-19 could pose to the people they live with, were ‘definitely’ taken into consideration when planning their discharge and 22% said this happened ‘to some extent’. This leaves one in five people (19%) saying their situation was not taken into account. Findings were more positive for non-COVID patients, 66% of whom said that their situation was ‘definitely’ taken into account when planning for them to leave hospital.
A lack of understanding of what might happen next can be particularly concerning for patients leaving hospital. Half of all patients (51%) said they ‘definitely’ knew what would happen next with their care after they left hospital. One in five patients (20%) felt they did not know what would happen next after leaving hospital. The problem was particularly pronounced among COVID-19 patients, where one in three patients (32%) said they did not know what would happen next with their care.
The majority of patients (74%) said they were told who to contact if they were worried about their condition or treatment after they left hospital. However, COVID-19 patients were less likely to say they were given this information than non-COVID patients (67% compared with 76%).
Information about medicines when leaving the hospital
Research has shown that poor provision of information around the benefits and risks of prescribed medicines can lead to non-adherence and medicines-related harm, resulting in negative health outcomes. However, when medical professionals share information about medicines in a way that patients understand, improving their knowledge on medicines as well as how to manage their own medicines when they leave hospital, adherence is improved.
Most patients were given information about any medicines they needed to take home. Seven in 10 (71%) were told what the medicine was for, and nearly two-thirds (63%) were told how to take it. However, a much lower proportion were given explanations about the side effects (35%). One in 10 (12%) said they were ‘given medicine, but no information’ at all.
COVID-19 patients were less likely than patients without a COVID-19 diagnosis to say they were given any explanation (about the purpose, administering and side effects) or written information about any medicine they were to take home.
Having integrated health and social care systems helps ensure that primary and community services are in place for patients that need them after discharge. The majority of people returned home after their stay in hospital (88%) or went to stay with family or friends (7%). Of these people, half (51%) ‘definitely’ received enough support from health or social care professionals to help them recover and manage their condition after leaving hospital. A quarter (25%) did not receive this support but said it ‘would have been useful’.
Again, COVID-19 patients were less positive. Three in 10 (29%) reported that support from health and social care services would have been useful but that they did not get any.