So-called ‘bed blocking’ - a horrible phrase - I prefer ‘delayed discharge’, currently costs the NHS around £900m a year. The number of people stranded unnecessarily in hospital has tripled in the past five years. It’s a huge issue.
It is also incredibly frustrating for the patients in question and, even more worryingly, potentially harmful to their health. After the initial episode of acute medical care that brings you there in the first place, hospital is not the best place to be, particularly if you are old and frail.
For instance, a report by the Health Foundation - which looked at discharges at Sheffield Teaching Hospital NHS Trust - found that on average, patients spent four times longer in hospital than first estimated by a consultant, and that as a direct result of delayed discharge, “some frail patients deteriorated while others were transferred to other parts of the hospital”, sometimes resulting in “vital information being lost, further deterioration, re-work and delay”.
The same study also highlighted that opportunities for timely discharge were often missed because key services involved in the process were simply not quick enough. These findings are not isolated and represent scenarios happening day in, day out, in our over-worked and under-staffed hospitals.
The King’s Fund has raised similar concerns, highlighting that the longer a patient stays in hospital, the more at risk they are of “infection, low mood and reduced motivation”, all of which can be detrimental to overall health and possibly result in avoidable re-admission.
‘So what has this got to do with investment in IT?’ I hear you ask. Well, quite a lot.
Appearing in front of a recent Commons health select committee, Jeremy Hunt was asked to give an example of investment that would make a sustainable difference to the NHS, rather than just being a “sticking plaster”. His reply focused heavily on IT.
He’s quite right, particularly in relation to bridging the current gulf that exists between prescribing and dispensing in hospitals.
Waiting for their medication to be delivered from the hospital pharmacy is a major reason for patients having a delayed discharge and it is not a new problem; back in 2008, a report by the Care Quality Commission said waiting for medication was the number one contributing factor.
Can there be anything more frustrating for a patient than having to wait because their medication is held up in a queue to be dispensed or worse still, hasn’t reached the queue yet?
Investment in IT has the potential to make a real difference here by enhancing data sharing and closing the prescribing/dispensing loop.
North Lincolnshire and Goole NHS Foundation Trust recognised this fact. They implemented an IT solution that, among other benefits, enables medicines to be ordered electronically from the ward, and creates a shared flow of information between all parties involved in the prescribing, pharmacy and administration processes.
The hospital halved overall dispensing time by 50%. For its acute medical ward, paper-based pharmacy collection and dispensing used to take almost six hours. With the new system, the first prescription now arrives on the ward in as little as 50 minutes. Prescribing is done digitally from the ward, replacing hand-written processes and reducing errors or further potential delays caused by misinterpretation.
The good news is that many more hospital trusts are now going to achieve these benefits, thanks to a new NHS England initiative. Announced just a few days ago, a central funding pot will help hospital pharmacies looking to implement or upgrade IT solutions to improve the quality and consistency of services.
It’s easy to hear an announcement like this and immediately dismiss it as a ‘paper shuffling’ exercise - one for the administrators. After all, how can anything IT related be anything but? Surely with the state of our NHS, money should be spent on patient care and not new software systems.
But that’s my point, in this context, investing in IT is a vital route to improved patient care. And not just in terms of the patients able to go home promptly and with the precise medication they require. With an aging population and soaring admission rates, demand for beds has never been higher. Helping one patient leave hospital is helping to free up resources needed to treat another.
Improving the dispensing of discharge medication is only one element in speeding up the discharge process. I would not like anyone to think it is the answer to the NHS’s bed woes. All too often the support network at home and in the community is patchy or entirely absent, and it needs intensive planning by a number of agencies before patients can leave hospital. But the technology already exists to make a dramatic improvement in one major area now. Why not take advantage of it?
IT really is about patient care.