Medical practice

Late-night hospital discharges to be probed

Hospitals are ‘throwing patients out of hospitals’ late at night to free up beds, according to an investigation by The Times.

The newspaper estimates that each year more than 400,000 patients are discharged from hospital between 11pm and 6am: many of whom could be elderly or vulnerable patients with inadequate care and support.

The Times sent Freedom of Information requests to 170 NHS hospital trusts and analysed data from 100 that responded. These recorded 239,233 late-night discharges in the past year, which would equate to over 400,000 across the country. This represents around 3.5% of NHS hospital discharges each year.

The Times report included case studies of several patients who had been discharged inappropriately. However, the data reported tells us only the raw number of patients discharged during the seven-hour window. It does not explain why they were discharged, what the patients experienced or how many of the discharges were inappropriate.

Sir Bruce Keogh, medical director of the NHS, told The Times that he will now investigate the issue of late-night discharges. Sir Bruce said: “Patients should only be discharged when it’s clinically appropriate, safe and convenient for them and their families. It is simply not fair to be sending people home late at night. We will look at this.”

Why might patients be discharged at night?

Although the story has been front-page news, it does not explain why so many patients are being discharged at night or how many of these discharges are inappropriate.

Individual patients’ stories support the case that some are being discharged wrongly at night to free up beds, but not all night-time discharges will be inappropriate. A small proportion of patients will always leave hospital at night for a variety of legitimate reasons, as some news sources have highlighted:

  • Alcohol-related admissions: binge drinking is thought to cause over a million NHS hospitalisations each year, and drunk patients attending A&E may sometimes be transferred to wards so their health can be monitored. They may be discharged or choose to leave at night once they are more sober.
  • Births: women who give birth to healthy babies often have no need to remain in hospital, and may choose to return home soon after their delivery rather than staying in hospital for the rest of the night.
  • Cleared emergencies: patients brought in at night for suspected emergencies can sometimes be briefly booked into wards for checks and tests. Once it is considered safe for patients to return home they may be discharged the same night.
  • Record-keeping practices: the way discharges are recorded in hospitals may not be totally accurate. For example, discharges recorded on paper might be keyed into computer systems at quieter periods such as night-time, suggesting a late-night discharge. Also, errors might occur when entering discharge times.
  • Deaths: some hospital record systems count a patient as discharged if they die while in hospital. Therefore the figures are likely to include a number of patient deaths recorded during the seven-hour period from 11pm to 6am.

Overall, while there is evidence that inappropriate late-night admission does occur in the NHS, it is hard to judge the scale of the problem without more revealing data. Sir Bruce Keogh, medical director of the NHS, has said he will investigate the matter.

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