These instructions are for mandatory delayed discharge data collection and submission from 1^st April 2000. They embody changes agreed by the Multi-Agency Working Group at its meeting in November 1999 and supersede the trial recording instructions issued in March (Version 1) and December (Version 2) 1999. Key changes from the Version 1 (March 1999) instructions are shown in italics.

An inpatient in an NHS hospital whose actual discharge date is later than the ready-for-discharge date is defined as experiencing a delayed discharge from the point of readiness for discharge (see definitions of "delayed discharge" and "ready for discharge date" in Annex B). The national data recording target group comprises all such inpatients in all specialties in NHS hospitals experiencing a delayed discharge at the quarterly census points. Please note that this covers patients awaiting internal transfer within the NHS as well as patients waiting to move into the community. Patients destined to undergo a change of setting for reasons other than their clinical readiness to move on to the next stage of care are excluded (eg patients destined to be shifted from a hospital to a community setting purely as part of a recommissioning programme).

Thus, a "snapshot" of patients in the target group experiencing a delayed discharge will be taken at the following census points:

30th June 2000

30th September 2000

31st December 2000

31st March 2001

The general approach for the data recording is to record information about these patients to the level of detail that is of most value locally, with the requirements of the national census as a MINUMUM. Although the national data recording takes the form of a quarterly census, data recording on delayed discharges is encouraged on an ongoing "real-time" basis. This will assist joint working by allowing identification of delayed discharges from when they first occur and the reason(s) for delay in discharge during the period of delay. The national quarterly census data should then become a simple by-product of this process.

National Census Dataset (Mandatory where applicable):

Hospital Location Code

Specialty Code

Ready-for-discharge Date

Principal Reason for Delay In Discharge at Census Point

Trusts and Local Authorities are free to record whatever data is of most value locally, provided the definitions are adhered to and all applicable mandatory national census data items are included. The extent of the local dataset will be largely determined by the types of statistical analyses that organisations may wish to produce for their own purposes, eg:

• % delayed discharges of total discharges by specialty
• % blocked beds of total occupied/available beds by specialty
• reason for delay frequency analyses, etc

Whatever the extent of the local dataset, it is recommended that all reasons for delay in discharge are charted for each patient during the period of delay, as more than one reason for delay may apply either sequentially or concurrently, and it will be easier to identify the principal reason for delay at the census point(s).

It is recommended that the local data spreadsheet is updated on an ongoing, "real-time" basis. Thus the census data can be easily generated on the day of the census using the following criteria:

• ready-for-discharge date IS BEFORE the census date

Examples:

You should have as many columns as you think you’ll need for reasons for delay in discharge - three are featured above just for the sake of the examples. It is suggested for practical reasons that five should be the maximum. Again for practical reasons, reasons for delay in discharge are likely to be recorded in chronological order of commencement, but don’t forget that more than one reason for delay can apply simultaneously. For the national census "snapshot", record one Principal Reason for Delay at Census Point (to full 2 or 3 digit detail).

The spreadsheet should be submitted by NHS Trusts and Directly Managed Units via Health Boards to Phil McNicol, Room B040, ISD, Trinity Park House on floppy disk within 10 days after each census point (eg by 10^th July 2000 for the June 2000 census), ensuring that you comply with all requirements for the passage of confidential data.

ISD staff are happy to visit sites for data recording training purposes by arrangement - please contact Phil McNicol, Definitions & Standards Manager, tel: 0131-551 8360 in the first instance.

A delayed discharge is experienced by an inpatient occupying a bed in a hospital specialty/significant facility who is clinically ready to move on to the next stage of care but is prevented from doing so by one or more reasons for delay in discharge. The "next stage of care" covers all appropriate destinations within and outwith the NHS (further inpatient episode, patient’s 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 which is determined by the consultant/GP responsible for the inpatient care in consultation with all agencies involved in planning the patient’s discharge, both NHS and non-NHS. Thus the patient is ready-for-discharge, but the discharge is delayed due to one or more:

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

Notes

1. This definition covers all hospital specialties and significant facilities, acute and long stay. However, 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.
3. Implicit within this definition is the existence of harmonious working arrangements between all agencies involved in the patient’s discharge planning, including efficient, effective and timely communication, which expedite the patient’s discharge to the optimum destination.
4. National data recording covers all delayed discharges, ie patients whose actual discharge date is later than ready-for-discharge date.
5. 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 data on delayed discharges.
6. Discharge planning for frail older people should take account of the guidance featured in the Social Work Services Group Circular "Community Care Needs of Frail Older People: Integrating Professional Assessments and Care Arrangements" (SWSG10/1998, 28/7/98) with particular reference to paras 28 - 38 "Discharging older people from hospital".
7. A hospital bed occupied by a patient whose discharge is delayed is a blocked bed.
3. The agencies involved in hospital discharge planning will vary from patient to patient.

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

Notes

1. Ready-for-discharge date and discharge date can be used to measure the length of time in days that a bed is blocked during an inpatient episode. The calculation is: "Discharge Date minus Ready-for-Discharge Date".
2. The "next stage of care" covers all appropriate destinations within and outwith the NHS (further inpatient episode, patient’s home, nursing home etc).