Patients harmed by extended hospital stays

Ian Sturgess, a former advisor to the NHS and leading geriatrician, has taken to Twitter to warn that patients are being harmed by staying too long in hospitals, and suspects many may sue the NHS for the subsequent damage to their health.

Referring to an “epidemic of harm”, Dr Sturgess said that inherent ageism is prevalent in the NHS system, which “assumes poor outcomes for older people”.

NHS report shows high levels of delayed transfers of care in England

In its most recent report, NHS England highlighted a decrease in the number of total delayed transfers of care, but that the number remains high. In October 2018, there were 146,900 total delayed days, of which 96,000 were in acute care. This was down from October 2017 where there were 169,000 total delayed days.

The report also found that the main reason for NHS delays in October 2018 was that patients were awaiting further non-acute NHS care, which could not be arranged in time.

These delayed transfers of care mean that many patients cannot be quickly discharged or moved to a more appropriate ward once they are medically fit, resulting in them spending unnecessary time in hospital beds. This ‘bed blocking’ can in turn adversely affect patients’ mental and physical health, as well as causing further delays for other patients in the system.

However, Dr Sturgess blamed consultants unable to construct a case management plan with a discharge date, which should be “a basic competency”.

Patients suffering from “hospital-acquired functional decline”

Dr Sturgess said that staying for too long in the hospital is causing some patients to suffer from “hospital-acquired functional decline”. In his estimation, about 50-90% of delayed transfers of care patients had suffered from the functional decline.

This deconditioning has been identified for decades by the medical community. The British Geriatrics Society has said that up to 65% of older patients suffer from hospital-acquired functional decline and that many of them then end up prematurely in care homes. In 2005, Dr Amit Arora of the University Hospital of North Midlands created the campaign “Sit up, get dressed, keep moving”, in an attempt to raise awareness about deconditioning and help to prevent it.

Hospital-acquired functional decline is common and costly, both in economic and human terms. The deconditioning can lead to readmission for patients after they are eventually sent home, and can limit their quality of life and independence.

Deconditioning is most common in older people, and as the NHS is treating increasing numbers of elderly patients as the population as a whole continues to age, it is easy to see how this has become a widespread issue within the health service.

The risks of hospital-acquired functional decline are not to be underestimated. Dr Sturgess has also said that the harm done by deconditioning is comparable to the impact of hospital-acquired infections C difficile and MRSA on the NHS 20 years ago, but that the harm from deconditioning is far more widespread.

It remains to be seen how many sufferers of hospital-acquired functional decline will bring medical negligence or personal injury cases against the Health Service.

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