Delays hinder hospital discharges
Delays in producing medication and discharge letters have led to patients being kept too long in Northern Ireland hospitals, an inspection report said.
Arranging transport between different health trusts and dealing with care homes has also extended the period that valuable beds are occupied.
The ambulance service should work with other health trusts to create a system which better supports transport for people being discharged from major acute hospitals, the Regulation and Quality Improvement Authority (RQIA) report added.
RQIA chief executive Glenn Houston said: "The review team also highlighted the need for patients ready to leave hospital to be prioritised during early ward rounds.
"This would allow medication to be prepared, transport to be arranged in a timely manner and ensure a smooth discharge from hospital seven days a week."
The 115-page Review of Discharge Arrangements from Acute Hospitals made 20 recommendations.
:: Junior doctors, who often draw up discharge letters, should be given more robust training emphasising the importance of the notes.
:: An estimated date of discharge is to be set within 24 hours of admission to hospital.
:: Ward rounds, which often precede a decision to send a patient home, should be structured to initially prioritise those with greatest clinical need, followed by those who are deemed ready for discharge.
:: Trusts should explore methods of making their care home forums more effective, and developing closer partnership working with care home providers, so that hospital release and other concerns are addressed in a mutually supportive way.
The discharge summary in most cases is produced by a junior doctor who may not have been involved in the patient's care, and is trying to put together a coherent picture from the hospital record.
The report said: "All trusts are aware of the need to begin to populate the discharge summary when the patient is admitted, and then to build it up throughout the patient journey. This will make the junior doctor's task much easier on discharge.
"All trusts are aware of the need to work towards electronic transmission of the immediate discharge summary, and are aware of the risks attached with sending the summary home with patients, making it their responsibility to pass it on to their GP."
The review team said direct pharmacy input into prescribing on wards led to a smoother and more efficient discharge.
"It helps to eliminate a large number of errors in the prescriptions that are written by junior doctors," the team said.
All trusts said dealing with care homes potentially led to delays.
"It was clear to the review team that those areas where there was an effective forum with care homes, there were fewer problems and all trusts need to have effective forums in their area."
The review team highlighted difficulties faced by the Northern Ireland Ambulance Service in transporting patients, who often are discharged in late afternoon but sometimes faced having to spend an extra night in hospital because a vehicle was not available. It said transport can cause problems for emergency departments.
"Patient stories supported evidence gained through other parts of the review, in that two of the main reasons they were kept waiting were due to delays in the production of the discharge letter and discharge medication.
"Patients also felt that though communication was generally good, they did not feel that they were sufficiently involved in the process and trusts must consider this in the future."