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Healthwatch Wirral

Discharge Survey

Wirral University Teaching Hospital NHS Foundation Trust

Elaine Evans

10/17-03/18

The following is a document collated from individuals whom have been discharged from Wirral university teaching hospital NHS Foundation trust. This report seeks to illustrate the opinions of carers, care homes, staff and the patients themselves.

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Contents

Foreword Page 2

Methodology Page 3

Findings Page 4

Conclusions and Recommendations Page 11

Acknowledgements Page 11

Glossary Page 13

Addendum Page 14

Appendix Page 19

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ForewordThis survey formed part of Healthwatch Wirral’s programme of work in 2017/18 to highlight the views and experiences of the local public who have used Health and Social Care services in Wirral.

In 2014 Healthwatch England identified discharge from hospital as a national priority. Their special inquiry, focussing on the experiences of older people, homeless people and people with mental health conditions, began in the summer of 2014. The resulting special inquiry report: ‘Safely home: what happens when people leave hospital and care settings?’ was published in July 2015. It is available via the Healthwatch England website: www.healthwatch.co.uk.

Healthwatch England heard from over 3000 people on their experiences of discharge and used available data to better understand the discharge process.

In their findings Healthwatch England listed five reasons things go wrong, including:

People experienced delays and a lack of coordination between different services.

People felt left without the services and support they needed after discharge.

People felt stigmatised and discriminated against and that they were not treated with appropriate respect because of their conditions and circumstances.

People felt they were not involved in the decisions about their care or given the information that they needed.

People felt that their full ranges of needs were not considered.

A number of the above findings are echoed in this report.

PurposeThe focus of this report was to capture related experiences from key participants in the process of hospital discharge.

Healthwatch Wirral's aim was to produce a report which could help to inform and improve the discharge process.


http://www.healthwatch.co.uk/

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MethodologyBetween October 2017 and March 2018 Healthwatch Wirral Representatives visited Wirral University Teaching Hospital, NHS Foundation Trust (WUTHFT) to conduct a survey on people’s experience of discharge from hospital.

We talked to staff involved with the discharge of patients, and conducted surveys with patients and their carers to capture the different perspectives of the key participants.

Healthwatch Wirral Task and Finish group developed separate specifically targeted questionnaires. They were designed with an aim to find out more about people’s experience of being discharged, any impact that their discharge experience has had on their health and wellbeing and whether the discharge process is meeting the Hospital Trust’s own Quality Standard.

We aimed to find examples of well managed discharge, examples of poorly managed discharge, and the key things local providers and commissioners may need to work on to improve.

Following discussions with Wirral University Teaching Hospital NHS Foundation Trust, it was agreed that Healthwatch Wirral, under the remit of Healthwatch ‘Enter and View’, would attend the Discharge Hospitality Lounge on various dates and times from October 2017 to January 2018 to conduct surveys. Healthwatch Wirral representatives also met with patients on a number of wards and provided them with a survey to complete after they had been discharged from the hospital.

Questionnaires were made available online and on the Healthwatch Wirral website.The patient questionnaires were completed either online or through interview with Enter and View Authorised Representatives.

Surveys were sent to local Care Homes to hear their experience of residents discharge from hospital. We also approached Wired, a local organisation who supports carers in the community, who made our questionnaire available to their members on line.

Ultimately, Healthwatch Wirral Authorised Representatives spoke to a total of 64 patients waiting to be discharged from the Discharge


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Hospitality Lounge. 19 of these patients informed Healthwatch that the hospital had arranged care packages for when they return home.

FindingsThe results from the 45 patients who did not require care packages when they returned home are reported below;

91% had not been told, on admission to hospital, how long they were likely to be in hospital.

45% were involved (including their relatives or carers) in their discharge process.

Most patients reported that they had only waited for up to 1 hour and 73% reported that the reason for their wait in the Hospitality Lounge was for transport home, with only 7% waiting for medication.

73%

7%

20%

If you are having to wait in the Discharge Lounge,

what is the reason?TransportMeds Other

up to

1h1-2h 2-3h 3-4 h

05

1015202530

How long have you been waiting in the Discharge

lounge?

amount of people

73% of patients informed Healthwatch that their family or carers had been informed of their discharge.

51% of patient reported that they had been discharged on the day and time they expected and 81% reported that they would recommend the hospital to their family and friends.


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87%

9%4%

Would you recommend this hospital to Family

and Friends?YesNoOther / no answer

The results from the 19 patients who did require care packages when they returned home are reported below;

94% had not been told, on admission to hospital, how long they were likely to be in hospital.

72% were involved (including their relatives or carers) in their discharge process.

6%

94%

Were you told how long you would be in Hospital ?

YesNoOther / no answer

72%

28%

Were you and your relat -ives involved in your dis-

charge process?YesNoOther / no answer

All of these patients reported that they had only waited for up to 1 hour and 67% reported that the reason for their wait in the Hospitality Lounge was for transport home, with no reports of waiting for medication.

78% of patients informed Healthwatch that their family or carers had been informed of their discharge.

33% of patients reported that they had been discharged on the day and time they expected and 89% reported that they would recommend the hospital to their family and friends


51%47%

2%

Were you discharged on the day and time that

you expected?

YesNoOther / no answer

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33%

61%

6%

Were you discharged on the day and time that you ex-

pected?YesNoOther / no answer

89%

11%

Would you recommend this hospital to Family and

Friends?YesNoOther / no answer

The support requested for patients on their return home ranged from STARS, District Nurse, Physiotherapy, Domiciliary Care and equipment. All of the patients surveyed reported that the arrangements went to plan apart from one patient who found the equipment hard to use. A transcription of the questions to patients waiting to be discharged from a ward is available in Appendix 1.

Summary of survey responses and Key findings from patients using the discharge hospitality lounge

Findings, in regards to discharge from the hospitality lounge, were largely positive (of 45 people spoken to in the discharge lounge 87% would recommend the hospital). Here are a few of the comments from patients we spoke to, “Happy with discharge process”. “Staff were kind and caring in the discharge lounge”, “Did not have to wait long for the ambulance to take me home”.

Generally the positive feedback conformed to similar trends; high standard of care, swiftness of discharge and the positive attitude of the staff during the process (an expanded list of comments can be found in the addendum, a transcript of the questionnaire can be found in appendix 3).

Negative comments received from patients using the Discharge Hospitality Lounge

The negative feedback we received were much more varied and rarely conforming to one trend.


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“The staff are not very caring. Put patient’s jacket on inside out”, “I felt rushed during discharge but staff were lovely”, “Not sure I had right treatment as my back pain turned out to be a fracture. I asked for an x-ray while in hospital but they did not do one”

Some of the trends indicated in this seem to highlight a rush to discharge patients when a more careful and measured approach may be required. Issues where an individual is improperly dressed or worse incorrectly diagnosed are clearly important issues to consider when discharging a patient. However even in the midst of this, some of the feedback does include reference to the positive attitude of staff which should be noted (an expanded list of comments can be found in the addendum).

Healthwatch Wirral Authorised Representatives provided a questionnaire to 60 patients waiting to be discharged from hospital. These patients were asked to complete the questionnaire when they returned home and send the completed forms back to Healthwatch in the stamped addressed envelope.Healthwatch received 21 responses and further comments are in the addendum.

61% of patients who responded reported that they had been discharged between 12-5pm

38% reported that they had been discharged between 5-8pm 62% were discharged on the day that they expected 62% said that they had experienced a delay on the day due to

waiting for a social care package, take home medication, waiting for the doctor to discharge them or for their discharge paperwork or waiting for a procedure i.e. ECG/x-ray before discharge.

90% of patients, before they were discharged from the ward, were asked about their living arrangements at home.

80% of patients, before they were discharged from the ward, were asked whether they had any support at home after discharge.

28% reported that their family or carer were involved in discussions about discharge

38% were told who to contact for help or advice 23% reported that they had support arranged for them when they

were discharged and the support ranged from T2A bed, Care Package and District Nurse. All of the support went to plan apart from the District Nurse, who did not visit on the day that the patient expected.

95% reported that they would recommend the hospital to family and friends.

Negative responses received


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The negative feedback that we received mainly seemed to be focused on the time waiting to be discharged “10am saw consultant who discharged me. 11am pharmacist reviewed meds and gave meds. 1pm saw Dr who asked me why I was still on ward. 4.30 Matron gave me discharge letter and I left ward. I was not sent to discharge lounge and sat and waited in a chair by my bed. I feel the bed could have been used by another incoming patient.”

For expanded responses see the addendum.

Positive responses receivedThe positive feedback received was focused on the standard of care “Everyone made sure I was safe, well looked after and cared for to ensure my experience was good. My discharge was safe, efficient, professional and kind.”, “I will write a thank you letter to the ward as I was really pleased with my care and discharge process”. The 2 positive comments indicate the professionalism and quality of care from the staff on these wards.

Carers ResponsesHealthwatch received responses from 5 carers. The majority of the carers indicated that they had been involved with their relatives discharge, but some of the carers indicated that their needs were not taken into account in regards to the discharge.

The main reasons for the delays were waiting for medication and because the carer had a disability which had not been taken into consideration when the patient was due to be discharged.

“Time was wasted due to staff not listening to the concerns of the carer and family” “There were no problems with my relatives discharge”. From these comments you can see that the feelings and comments were mainly balanced with issues surrounding care after discharge or with the discharge plan itself.

The services, agencies or community based support arranged to support the carers were STARS, OT and reinstated care support packages.For further responses from carers see the addendum and a transcription of the questionnaire can be found in appendix 5.

Care Home experiences of the Discharge process

Healthwatch sent out a survey to local Care Homes and received 15 responses:-

60% reported that residents rarely experienced a good discharge


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33% reporting that residents have a good discharge from hospital back to their Care Home.

The themes surrounding any issues in regards to the discharge process generally surround the communication between the care homes and the hospital. The responses from care homes would indicate that information regarding the patient/resident comes last minute before transfer and that it is not always as complete as it should be. In addition to the breakdown of communication another theme seems to be issues surrounding medication, with either little information in regards to the medication needs of the patient and sometimes with no medication being supplied with the patient at the time they are transferred

“We are notified at very short notice sometimes. We like to assess residents before discharge to see if we are able to meet their needs but are usually notified on the day they are to be discharged”

“Medications - not being available, wrong ones sent, items missing. People waiting for blood tests on the day of discharge despite discharge planned days earlier. Documentation was not available, no catheter passports, nursing assessments not received. Transport not arranged on the day until late resulting in residents arriving at the home after 8pm when morning discharges have been requested”For further comments from care home managers see Addendum, a transcription of the questionnaire can be found in appendix 4.

We asked the Care Home Mangers how they thought discharge could be improved

The themes surrounding the improvement suggestions for the transfer process are as you would expect surrounding communication and provision of medication for patients. The comments would indicate that the most important part of discharge is the information in regards to the patient/residents condition upon leaving the hospital. This is essential information to the care staff upon creating a care plan for a resident.

“It would be good if ward staff could keep us informed of the condition of our residents and any significant changes in their health and wellbeing, sufficient time needs to be given so that we can go and assess to ensure that we can still meet their care needs.”

Training, clear lines of responsibilities, better communications

To be clearer on transfer, core assessments in place, all discharges should be body mapped on discharge to clear up any causes for concern on arrival at care home.

Better communication. Discharge summaries. Adequate equipment to be supplied


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For further comments in regards to the safe discharge from hospital to a care home see the addendum

Hospital Staff ResponsesHealthwatch Representatives spoke to 8 members of staff and asked them if they thought the discharge process could be improved and what they thought hindered the discharge process.

Yes 75%

No 25%

Do you think that the discharge process could be improved?

Most staff reported that their main concerns were around; staff shortages within the department pharmacy issues around medication to take home poor communication between the wards and the discharge

hospitality loungeA transcription of the questions asked to members of staff can be found in appendix 2.

Other issues reported by members of the public - Information received through HW monitoring or through the Info bank at WUFTH


staff sh

ortage

s

Pharmacy

issues

lack o

f resource

s

co-ordinating c

are

transp

ort

home support

arran

ging M

DT's

Arrangin

g care

home plac

emen

ts IMC, D

2A

Informati

on communica

tion processes

challenges

from fa

milies

0246

What staff thought hindered and what did not hinder the safe and timely discharge for pa-

tients

HinderanceNot a hinderance

To clarify the concerns indicated in this graph

1. Staff shortages 2. Pharmacy issues3. Lack of resources4. Co-ordinating care 5. Transport 6. Home support 7. Arranging MDT’s 8. Arranging care

home placements IMC, D2A

9. Information communication processes

10. Challenges from families

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Several members of the public approached Healthwatch staff working in the Info bank at the hospital to ask about discharge procedures and packages of care for when their relatives are discharged.

A member of the public reported that they had only received notice that their relative was being discharged on the day and were concerned that they were about to go on holiday and were not given time to make care arrangements.

Relative reported that a patient was being discharged too soon as they patient was still very poorly.

Patient reported that they had had a long wait for medication on discharge

A patient due to be discharged did not feel well enough and Healthwatch contacted the discharge lounge staff who refereed the patient to the emergency department for reassessment as they do not have access to doctors in the discharge lounge.

A relative of a patient who has dementia, reported that they had not been involved in the patient's discharge, They felt that the patients circumstances at home had not been taken into consideration ( they lived alone) and the family were only notified when the patient was ready to be collected and taken home.

Person reported a concern over a delay in the allocation of a nursing home for CHC

Person reported that they were concerned that their relative had been discharged without any support at home.

Patient reported that they had to wait a long time for Take home medication when they were discharged from the ward.

Person was concerned about their relatives discharge and reported that when they voiced their concerns to staff on the ward, the staff did not treat them with respect or courtesy.

Patient reported that their discharge went smoothly, their medication was ready and any after care was fully explained to them.

A relative reported that they were concerned about the lack of notice given to them when the patient was being discharged that day. It made it very difficult for them to arrange for a family member to be at the home of the patient on their discharge.

Patients relative reported that they were concerned that the patient was discharged home too early. The patient could not breathe and would not have coped without family support

It appears from this list that medications, communication and lack of account of home environment are strong indicators of poor discharge.

Conclusions


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Patients appeared comfortable and well cared for by staff while they were waiting in the Discharge Hospitality Lounge and it was commendable that 83% of these patients would recommend the hospital to family and friends

Healthwatch Wirral feel that the delivery of an effective discharge could be better enabled by working in partnership with staff, patients and carers to ensure quality outcomes. Discharge from hospital needs a process of strong commitment to joined up policies, procedures and delivery.

Recommendations Improve communication throughout the hospital and with

patients and carers Ensure that there is better collaboration between the hospital

and the care home Ensure Discharge summaries are accurate Improve the provision of take home medication Discharged patients at an appropriate time i.e. earlier in the

day Ensure that any clinical interventions such as blood tests,

ECG’s are completed without causing undue delay to patients being discharged.

Acknowledgments

Healthwatch Wirral would like to thank,The ‘Discharge from Hospital Survey’ Task and Finish Group members who developed the aims and purpose of the survey and designed the questionnaires.Staff at Wirral University Teaching Hospital NHS Foundation Trust who made us welcome in the Discharge Hospitality Lounge and Wards.Wired, who distributed the questionnaire to their members (carers)Patients, Carers and Professionals who shared their experiences of hospital discharge at Wirral University Teaching Hospital Foundation Trust with Healthwatch Wirral representatives.Healthwatch volunteers who conducted the surveys with patients.Healthwatch staff who contributed in the production of the report and the visits.Healthwatch Quality Assurance group who reviewed and scrutinised the report.Glossary

CCG Clinical Commissioning Group


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CHC Continuing Healthcare

DN District Nurse

DNAR Do not attempt resuscitation

DOB Date of birth

GP General Practitioner

MDT Multi-disciplinary team

NOK Next of kin

RNHA Registered Nursing Home Association

STAR Short Term Assessment and Reablement

TTH To take home (medication)


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Addendum and Appendix


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Addendum Further positive comments from patients using the discharge hospitality lounge

“I had the best of care from lovely staff” “Good experience in discharge lounge and ward. Staff very caring and friendly” “I had a good experience and everything went to plan. Staff worked very hard” “Brilliant care on ward 10 and in discharge lounge”“All fine, good experience. Staff and ambulance staff in discharge lounge all very caring” “I was very happy with my care and the support I was promised when I got home went as planned”“Received good care on wards 20 and 21. Staff in discharge lounge treated me well”“Good experience. Staff in discharge lounge very caring despite being very busy and having to deal with difficult patients”

Further negative comments from patients using the discharge hospitality lounge

“Not given enough information on my condition, would have liked more notice on my discharge as I was only told this morning. I did not feel ready to be discharged”

“Not happy that my relatives had not been contacted before I was due to be discharged. Discharge was quite abrupt (ward 38) as I was not expecting to go home today. No time to pack”

“My only disappointment was that I was told I was going home then told I was not on several occasions”

”Patient had long wait and seat was uncomfortable in discharge hospitality lounge. My Son, who is a nurse, would have like more involvement in discharge process”.

“Not impressed with the time it took to arrange care package. The original package arranged expired when patient was in hospital for more days than expected. Not impressed with organisation that provided care as they did not give patient enough time and sent different carers on each occasion.”

Further comments in regards to waiting for discharge“Delays in receiving my medication at discharge was the only problem” “Waited a long time for my medication before going home. I was not sent to discharge lounge to wait.”

Further comments from carers


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One respondent reported that they had to have a community OT visit them at home in order to have a report to have a wet room fitted in the house. In the meantime they had to wash their relative with a bowl of water at the kitchen table each day. The STARS team suggested that they purchase a sponge on a stick to make washing easier but neither the carer nor patient could manage this. They were informed that help at home would decrease and that they should purchase private domiciliary care, which they could not afford.Another carer reported that they had only found out that their relative was ready to go home when their relative, who has dementia, phoned them to say they needed to be collected. The carer made 3 attempts at ringing the ward and nobody seemed to know. They then got a phone call back to say that their relative was being discharged.

Further comments from care home managers “Incorrect information about the resident resulting in unsafe discharge and even unsafe placement. Residents then must move to the right placements after a lot of backwards and forwards communication with social services. It is very stressful for the resident and for the families and causes delays in payments for both homes, and then later after the placement someone changes their minds and the resident must move to another placement. Again, very stressful for families “Wrong assessments by either the ward staff or the discharge teams who sometimes display a lack of knowledge in funding needs. A resident is assessed as needing nursing and then later after the placement someone changes their minds and the resident must move to another placement.”

“Medications - not being available, wrong ones sent, items missing. People waiting for blood tests on the day of discharge despite discharge planned days earlier. Documentation not available, no catheter passports, nursing assessments were not received. Transport not arranged on the day until late resulting in residents arriving at the home after 8pm when morning discharges have been requested”“Usually around medications errors. Also, quite often word does not give true reflection of resident’s health, quite often hospital does not liaise with DN’s and therefore discharges are unsafe”

“ Insufficient information regarding medications started or stopped during admission, delay in paperwork reaching GP’s Insufficient information regarding any treatments, investigations and results that may have occurred during admission- this is particularly relevant if current residents become acutely unwell and are then discharged back to us after treatment we do not know what has been done We cannot get updates or information during admission as we are not ‘family’ however as the


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Long term care providers for residents (and nurses) we often have insight that may be helpful”“Medication, accurate information, missing or conflicting info”“Transfer to home without prior notice to staff.Transfer to home with limited or incorrect information, e.g. walking independently, but transferred on stretcher with considerable mobilising issues.Residents being transferred late night early morning.Potential residents being transferred to home from hospital without discussion. We have had cases at weekend were funding had not been agreed, requiring resident to be sent back to hospital and issues from CCG were we have decided in best interests of resident to complete admission and chase funding after.Transfer to the home when staff have been informed CHC and home management need to review prior to discharge as needs have changed on a bank holiday without discussion”“Medication, either not supplied or only a couple of days. Unclear instructions of dosage particularly for items such as insulin, warfarin. Residents arriving late which causes them anxiety.Family not notified.On one occasion ward had not ordered oxygen for patient.Residents arriving in a poor state, wet, dirty, unwashed.”

“New service users who have continence issues have no product discharged with them and can be a lengthy and frustrating procedure to fix this problem”

“Poor Discharge Information – My team often have to chase this up. Discharged at inappropriate times – late at night which is not a problem operationally but sometime seems stressful for resident. Every recent discharge they have sent residents back without DNAR – this is very serious and I was thinking of making a complaint to the NHS – but not sure who????”

“Access to information at the point of assessment as the relevant detail is stored on computer. Rarely do any of the nurses have time to sit down with you to go through that information.Core value information from Social Workers/Discharge Coordinators for contracted beds from hospital is quite often out of date, sometimes irrelevant, cut and pasted for each section on occasion and lacks detail especially around issues such as mobility and capacity. Requirement for continence aids not being supplied and as a care home we do not carry stocks as they are all individually allocated on a three month order which in itself is ridiculous”


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“The resident is usually not discharged with a list of medications they have recently received. For example, there is no record of when or if they had received their regular medications, or the last time they had analgesia. Occasionally the discharge summary is poorly written or incomplete. This means that we have to call the wards for further information.No discharge summary. Lack of communication from ward. Late dischargeDischarge timing arrival at Care home very late in the evening.Medication not always with client.Poor documentation, missing medication, Missing discharge letter, late discharge i.e. after 5pm”

“The staff on the ward do not appear to be involved in the discharge process they are able to tell you if someone is medically fit but do not know about funding and nursing assessments. The discharge coordinators are very good but if a patient is privately funded they are not always involved and staff do not seem to realise when they require a nursing assessment and this delays the discharge”

“Once preadmission assessments are completed hospital want to discharge sometimes that day and are unhappy if we ask for time to ensure we are ready- we are treated as thought we are delaying when actually one of the reasons for the preadmission is to ensure that everything is in place prior to discharge to ensure safe transfer. Funding is another issue, we have to ensure that we have something in writing to ensure funding is in place and again we are often treated as though we are delaying deliberately. Generally the feeling is that the discharge will be poor and we put as much in place as possible to fill in the gap- basically ‘just bring them in and we will sort everything later”

“I feel that sometimes we are pushed to take residents before we have enough information and or enough time to prepare for the admission, I have felt sometimes that they feel I am being difficult if I say I need more time to put things in place. Eventually though they do understand, I have had in past more than one-person phoning asking why I couldn’t take a resident on a particular day and I felt very pressured. I do understand why but it results in unsafe discharges and admissions”

“Staff in hospital can be rude when we decline a discharge until we get more information. On occasion we have had people referred who have issues for which the home is not registered to support”

Further comments in regards to the safe discharge from hospital to a care homeBetter collaboration between the hospital and the care home. Would like to be able to see the notes of the person being assessed for discharge


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Have the co-ordinators doing a daily template of vacant beds across Wirral. Have a dedicated team working alongside Discharge co-ordinators seeking out vacancies on a daily basis and housing between hospital and care home (Similar to bed brokerage system in Liverpool City).

The new trusted assessor role has been developed which should improve things. Each ward should have the same discharge process and follow it

I think the care home should contact the hospital when funding has been agreed and organise discharge, rather than other way around. I think it should be policy that care home manager has consented to admission prior to resident turning up on doorstep.

As per RNHA input with APH frail and vulnerable residents, in general should be transferred at appropriate times, not late at night.“A nurse to spend ten minutes with the person completing the pre admission so a proper handover can be done. If they know the person is soon to be discharged could they prepare a pack that contains pertinent information for example NOK, GP, Allergies, Medical History past and previous, medications, DOB, NHS number, capacity. Etc.If they have a catheter to have the date it was inserted, make, size and why it was inserted. Not to discharge after 4pm, I do realise this is problems with the discharge lounge but if we have a late admission we don’t have time to deal with any missing information or medication.”

“Discharge teams/ social workers should have less pressure to free up beds.Discharge teams/social workers should perhaps come to the home to speak with the manager and get a better understanding of the pressures involved.More respect for the professionalism within the care home (many of us are VERY experienced and mature, there isn’t much we have not come across in our time so we do know what we are talking about).”

“Communication and better organisation. Share information with us and tell us when are residents have died!”

“When a client is medically fit for discharge it would be helpful if the home was included in the MDT meeting where the client’s ongoing care could be discussed. And that maybe instead of using the ambulance service and waiting six hours in the discharge lounge a client could be sent to the home by a contracted service.”

“It is very hard to assess the patients now all the information is on the computer; it is hard to access the required information. The TTHs should be ordered as soon as patient is medically fit.There needs to be a more coordinated approach so that the nurses on the ward know where the discharge plans are up to.”


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AppendixAppendix 1) Questions asked of individuals upon discharge from a hospital ward

Were you told how long you would be in Hospital?Were you asked about living arrangements at home?Were you asked whether any support at home after discharge?Were your family or carer involved in discussions about discharge?Were you discharged on day and time expected?Any delay in hospital discharge?Reason for delay?What time were you discharged?Was your family/carer told when you would be discharged?Were you or they told who to contact for help or advice?Following questions to be answered when homeDid your GP, carer, care home receive info about treatment and follow up care?Was any support arranged for you when you were discharged?Did it go to plan?


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Were you told that care services, nurse other therapies would contact?If so did it happen?Have you been readmitted since original stay?If yes was it related to your previous admission?Would you recommend the hospital?

Appendix 2) Questions asked of staff in regards to what effects the time for discharge from hospital.

Answer yes or no to the following if you think they effect discharge times. Staff shortagesPharmacy issuesLack of resourcesCo-ordinating careTransportHome supportArranging MDT'sArranging care home placements IMC, D2AInformation communication processesChallenges from families

Do you think that the discharge process could be improved?


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Appendix 3) Questions asked of patients waiting in the discharge lounge.Were you told how long you would be in Hospital? During your stay were you asked whether you lived alone or had friends or family who could support you on discharge?Were you and your relatives involved in your discharge process?Were you discharged on the day and time that you expected?How long have you been waiting in the Discharge lounge?If you are having to wait in the Discharge Lounge, what is the reason? Have your family/carer been told that you are being discharged?Has the hospital arranged any support you may need when you go home?Would you recommend this hospital to Family and Friends?Is there anything else (positive or negative) you would like to tell us about your experience of being discharged?Additional questions for patients who had packages arrangedWere you told how long you would be in Hospital? During your stay were you asked whether you lived alone or had friends or family who could support you on discharge?


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Were you and your relatives involved in your discharge process?Were you discharged on the day and time that you expected?How long have you been waiting in the Discharge lounge?If you are having to wait in the Discharge Lounge, what is the reason? Have your family/carer been told that you are being discharged?Has the hospital arranged any support you may need when you go home?Would you recommend this hospital to Family and Friends?Is there anything else (positive or negative) you would like to tell us about your experience of being discharged?Did your GP/carer/ care home receive all relevant info?What support was arranged?Did it go to plan?Were you told that health or social care staff may contact you?If yes did this happen?Have you been readmitted?If yes was it related to your previous admission?

Appendix 4) Questions asked of care home managers (October 2017).How often have residents experienced a good discharge?What are main problems around discharge?Are you involved early in the planning of residents assessment and discharge to your homeDoes the hospital keep you adequately informed of services/care delivered to your resident in the hospital?Does the hospital discharge team give you sufficient notice to provide appropriate services for discharged patients?Do you provide IMC/Respite/ D2A etc.?If so are all of the referrals from the hospital appropriate?How do you think that discharge could be improved?


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Appendix 5) Questions asked as to the experience of carers of individuals awaiting discharge.Are you main carer?Were you involved in planning discharge?Were your needs as a carer taken into consideration in planning your relatives discharge?Was there any delay in the actual discharge?If yes what was the reason for the delay?Was the time of discharge and arrival home as planned and was it convenient?Did your relative arrive home with all required medications? Were you given clear instructions on how and when the medication was to be taken?Did your friend/relative require any specialist equipment?If yes was it made available on time?Was there any need for alterations to be carried out in your relative’s home prior to discharge?


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Which services, agencies or community based support were arranged to support you or your relative?Has your fried/relative been readmitted to hospital?Would you recommend the hospital to friends and family?Is there anything else you would like to tell us about your experience of your relative's discharge from hospital?


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