HSE data ‘not reliable enough’ on discharges from hospitals
An expert group examining the scale and causes of delayed discharges from hospital has been unable to produce any meaningful recommendations to tackle the problem this winter because of the poor quality of data available to it.
The “lack of robust data” means the independent expert review of delayed discharges is also unable to produce a costed implementation plan.
Minister for Older People Jim Daly said he “accepts that the data is not reliable enough”.
The review said the current weekly national delayed discharge report is “not fit for purpose”. Mr Daly said he favours a daily delayed discharge count, mirroring the trolley count, to “shine a light on delayed discharges” which he said are arguably, “a bigger problem than people on trolleys”.
Asked who would do the counting, he said “it could be hospital management”.
In the absence of complete data, the working group applied a Dutch measurement model which identified almost eight times the number of delayed discharges in Irish hospitals in 2017 than the number actually recorded — 67,149 compared to 8,817.
Graham Knowles, who chaired the review, said the absence of “a clear national policy and consistent approach” regarding delayed discharges has resulted in “significant under-reporting”, inhibiting implementation of measures to manage the deficit.
The review said there is “a disincentive” for public hospitals to classify private patients as delayed discharges because private insurers “often cease paying” when this happens.
Mr Knowles, the chairman of the University of Limerick Hospital Group, said the cost of delayed discharge is “not borne by the patient alone” but also impacts on patient flow, such as the time spent in emergency departments.
He also noted that while there is a definition of a delayed discharge — a patient who remains in hospital after a senior doctor has documented that they can be discharged — interpretation varies widely.
The review recommends a national policy be developed to provide “an unambiguous definition and guide to categorising delayed discharges”.
It also recommends an assessment of supports available to patients and families regarding Fair Deal, the Nursing Home Support Scheme (NHSS), which figures in the top four reasons why discharges are delayed. Other reasons include financial issues, waiting on rehabilitation, and delays in the home care package application process.
The review said many families “face significant challenges completing the Fair Deal processes particularly where there may be legal or financial complexities”. It said submissions made to the review “suggest that some families do not cooperate with the NHSS process”.
The review recommends the Department of Health ensure the development of a policy, “with national HSE responsible for ensuring its consistent implementation”, and subject to external audit.
