6. The quarterly data recording trial will run for 1999/2000 and consistent information on a national basis will be recorded from April 2000.

7. A further specification note will issue from the Information and Statistics Division of the Common Services Agency.

Yours sincerely

1. Different Health Boards and local authorities are working to different definitions of delayed discharge. To resolve this a working group comprising The Scottish Office, Health Boards, NHS Trusts and Local Authorities, established by the NHS, Information and Statistics Division of the Common Services Agency, conducted data recording trials during October and November 1998. These trials focused on the key events and phases of in-patient stays which resulted in delayed discharge, together with reasons for delays.

2. Ready for discharge date is the date on which a hospital in-patient is clinically ready to move on to the next stage of care. This is determined by the Consultant/GP responsible for the in-patient care in consultation with all NHS and non-NHS agencies involved in planning the patient’s discharge. A patient who continues to occupy a hospital bed after the ready-for-discharge date during the same in-patient episode experiences a delayed discharge.

3. With effect from 1 April 1999, the agreed definition for delayed discharge and the basis on which the data should now be collected is as follows:

• The "next stage of care" covers all appropriate destinations within and outwith the NHS (further in-patient episode, patient’s home, residential home, nursing home etc).
• The date on which the patient is clinically ready to move on to the next stage of care is the ready-for-discharge date (see paragraph 2 above) which is determined by the consultant/GP responsible for the in-patient care in consultation with all agencies involved in planning the patient’s discharge, both NHS and non-NHS.

• Health reasons
• Social care reasons
• Patient/Carer/Family-related reasons

4. Ready for discharge date and discharge date will be used to measure the length of discharge delay in days during an in-patient episode. The calculation is: "Discharge Date minus Ready-for-Discharge Date". In this regard the "next stage of care" covers all appropriate destinations within and outwith the NHS (further in-patient episode, patient’s home, residential home, nursing home etc). The national data recording will cover delayed discharges whose actual discharge date is 2 days or more later than the ready-for-discharge date.

5. These definitions cover all NHS hospital specialties and significant facilities, acute and long stay. Care must be taken in interpreting data on short stay patients where there is insufficient time to carry out necessary discharge planning between the patient’s admission date and ready-for-discharge date.

6. Implicit within the definitions is the joint working arrangements between all agencies involved in patient discharge planning.

7. Multi-agency discharge processes are complex – many agencies can be involved in the care of and discharge planning for a single hospital patient, and account must be taken of the patient’s own wishes and family/carer issues. This definition does not preclude the existence of locally-agreed timescales and criteria for the different components and stages of discharge planning which suit local circumstances and which must be taken into account when interpreting date on delayed discharges. For example a patient’s delayed discharge should not be attributed to non-availability of a place in the community if the locally agreed time for such a move to take place has not expired.

8. The trial target group comprises all in-patients in all specialties (acute, mental health and long-stay) in NHS hospitals whose actual discharge date is 2 days or more later than the ready-for-discharge date and are experiencing a delayed discharge at the quarterly census point. This covers patients awaiting internal transfer within the NHS as well as patients waiting to move out into a social or home care environment.

9. All NHS Trusts should participate in the data recording trial, preparatory to the mandatory data recording from 1 April 2000.

10. The general approach for the trial is to record information about delayed discharge patients to the level to detail that is of most value locally, with the requirements of the national census as a minimum. Although the national data trial will take the form of a quarterly census, data recording on delayed discharges is encouraged on an ongoing "real-time" basis. This will allow identification of delayed discharges immediately they occur and the charting of reason(s) for delay in discharge during the period of delay.

11. The suggested datasets are as follows.

• Hospital Location Code
• Patient ID
• Specialty Code
• Date of referral for assessment
• Ready for Discharge Date
• Discharge Date
• Reason(s) for Delay In Discharge (see Annex C)

• Hospital Location Code
• Specialty Code
• Ready for Discharge Date
• Principal Reason for Delay in Discharge at Census Point (see Annex C)

12. A "snapshot" of patients in the trial target group experiencing a delayed discharge will be taken at the following points:

13. Full data recording instructions are available from Information Services Division, Scotland. (Phil McNicol, Definitions and Standards Manager, Trinity Park House, South Trinity Road, Edinburgh EH5 3SE, 0131 552 6255).

Social Care Reasons:

Healthcare Reasons:

Patient/Carer/Family-Related Reasons: