New HSE rules aim to speed up discharge of well patients

Older patients who are well enough to leave hospital may have to accept the long-term care that is available rather than wait for their preferred option, under new HSE rules.

Remaining in hospital after treatment is not “a choice to be exercised” for patients whose discharge has been delayed, HSE chief executive Bernard Gloster and chief clinical officer Dr Colm Henry warn in advice issued to all hospitals.

Their instructions, issued last week, aim to speed up the discharge of well patients from hospital to make room for sick ones languishing on trolleys in emergency departments. On a typical day, the number of so-call delayed transfers of care (DTOC) exceeds 500, and such patients may outnumber those waiting for admission.

Over 200,000 bed-days were lost last year due to delayed discharges.

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In order to achieve the best possible outcomes, the memo states, hospitals are “mandated” to put “available options” to any suitable DTOC patient who has been approved for the Fair Deal nursing home scheme or is assessed as suitable for post-acute transition care, while their final care plan in being completed.

“We want to work compassionately with patients and families while equally ensuring that remaining in hospital post an acute phase of care is not any appropriate arrangement to continue or a choice to be exercised,” according to Mr Gloster and Dr Henry.

“Patient safety and appropriate access to care are critical considerations in all discharge planning and decision making.”

The memo references the availability in south Dublin of long-term care beds, even while larger hospitals in the area have DTOC patients who are approved for nursing home places.

“It is regularly the case that there may be patients approved through NHSS (nursing home support scheme, or Fair Deal) for long-term care on the south side of Dublin and the only availability is on the north side and similar happens in other regions of the country.

“At all times the HSE wants to respect patient and public choice and self-determination as would be reasonable in any care context. However, it is recognised to be the case that what is available may have to be accepted while a patient’s choice is awaited.”

“It is simply not sustainable for us to continue to care for people in acute hospital settings when their acute care has finished and has been approved through NHSS process for long-term care, even though at times the available onward nursing home may not be the first choice of the patient or their family.”

Emergency medicine doctors have welcomed the HSE’s new guidance, saying it can improve bed availability and reduce the time patients spend on trolleys.

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For every 82 patients who are delayed more than 6 hours in an ED, there is an excess death, the Irish Association of Emergency Medicine pointed out.

“It is unconscionable that a patient who needs an inpatient bed for acute treatment is unable to go to one because the bed in the acute hospital is being used for a patient who could have their care needs met elsewhere.

“Given the shortage of acute hospital beds in Ireland it is simply not feasible to allow these beds be used for patients who do not need the services of an acute hospital and who could be managed safely in a nursing home or community hospital facility.”

Investment in additional bed capacity in hospitals and the community is vital, the group added.

Geriatricians have told the HSE they will not co-operate with new plans to medically assess older patients before transfer from hospital to a nursing home, The Irish Times reported on Monday.

Every year, about 3,000 patients who are too frail to go home are transferred from hospital to a nursing home or other long-term care.