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Discharge procedures

Mark Paul made this Freedom of Information request to University Hospitals Coventry and Warwickshire NHS Trust Automatic anti-spam measures are in place for this older request. Please let us know if a further response is expected or if you are having trouble responding.

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Dear University Hospitals Coventry and Warwickshire NHS Trust,
I wish to know the following.

I would like the answers for EACH question PRE-pandemic AND POST-pandemic.
In short, if the procedure has remained the SAME both before AND after the start of the pandemic, please say so.

If there have been CHANGES or DIFFERENCES introduced in the standard operating procedure after the start of the pandemic, kindly indicate this, and state WHAT the changes are.

1) What is the standard procedure you follow when discharging in-patients from hospital?

2) Who decides when it is time for the patient to be discharged?

3) Is the decision to discharge taken purely by the medical team in charge of the patient's care, or is it influenced by the managers, depending on bed availability?

4) Is there a discharge team who coordinates discharges from hospital?

5) Is this discharge team the SAME for EVERY ward in the hospital, and for every speciality, or is there a SEPARATE discharge team for each ward and/or speciality?

6) What qualifications do the members of the discharge team hold? For example, are they former nurses, technical staff, managers, what?

7) Who were the members of your discharge teams for Orthopaedic surgery, Geriatrics, and Internal Medicine, for the years 2018, 2019, 2020, and 2021?

8) Whose responsibility is it to apprise the patient, and/or their next of kin, of the decision to discharge? Is it the responsibility of the discharge team, the medical team, or both?

9) Who are the current members of your various Discharge teams?

10) If the patient is a minor, or they are an elderly patient with advanced dementia who does not have the mental capacity to comprehend discharge decisions, does the discharge team, or the medical team, or both, hold discussions with the next of kin or family members, regarding the decision to discharge?

11) If such discussions are held with the next of kin, who are they by? The discharge team, the medical team, or both?

12) Are there any circumstances under which the standard operating procedure that governs hospital discharges is bypassed, and not followed? If so, what are those circumstances?

13) Are there any circumstances under which the next of kin of the patient are not informed about the decision to discharge, and a discharge goes ahead without their knowledge?
If so, what are those circumstances?

14) Are there any circumstances under which a discharge to the community goes ahead without the consent of either the patient, or their next of kin (in the case of patients with advanced dementia)? If so, what are those circumstances?

15) What are the guidelines and strictures issued by the General Medical Council, the regulatory body for doctors, with respect to hospital discharges and how they are conducted for patients who have capacity, and for patients who are either minors or lack capacity (e.g. elderly patient with advanced dementia)?

16) Is there a similar code that has to be followed by the non-medical members of the team, such as managers?

17) Does the General Medical Council stipulate that doctors have to be actively involved in holding discharge discussions with either patients or their next of kin, prior to discharge?

18) Do all NHS hospitals in the 4 countries that comprise the United Kingdom (England, Wales, Scotland, and Northern Ireland) follow the exact same discharge process, or does it vary from Hospital Trust to Hospital Trust and/or Country to Country (for e.g. does Wales follow different guidelines from England)?

19) Has there ever been an instance of a patient getting discharged from hospital without discussions first being held with either the patient, or the next of kin (if the patient has advanced dementia), and if so why did this occur?

20) Have there been significant changes in discharge procedures after the start of the pandemic? If so, what are the changes? Have these changes, if any, been reversed now, or are they ongoing? If ongoing, how long will they continue?

21) WHEN, WHY and by WHOM was the decision to prevent patients' relatives from visiting them on the wards taken, at the start of the pandemic?

22) Was this decision taken by the top managers at the hospital, or was this a directive issued by the Department of Health and Social Care? If the latter, was it simply "guidance" or a rule that had to be strictly enforced?

23) Was this decision implemented nationwide, or was it down to individual hospitals to decide for or against imposing it on their patients?

24) Is the above rule (about no visitors) ongoing or can patients' relatives now visit their loved ones on the wards?

25) During the time that no visitors were permitted, were the loved ones and next of kin of patients who were being discharged allowed to see them either just BEFORE or DURING discharge, if aforementioned patients were not being discharged to their own homes (e.g. they were returning to a Nursing Home)?

26) If yes, did the hospital or discharge team notify patients' next of kin of the impending discharge, with at least 24 hours notice or more, to give the relatives time to get to the hospital and see their loved ones prior to them being sent back to their Nursing home (given that no visitors were allowed into Nursing homes once the pandemic started)?

27) If no, why were relatives not given the chance to see their loved ones at least briefly prior to discharge, given that they would then NOT be in a position to visit them in their Nursing Homes for a period of several months at least?

28) During the time that no visitors were allowed into wards, did ward staff ensure that relatives and next of kin were kept informed of every aspect of their loved ones' care and progress? If so, how did they do this?

29) During the time that no visitors were allowed into wards, did ward staff ensure that relatives were still able to communicate with their loved ones via telephone? Was an attempt made to permit bed-bound patients, in particular those elderly patients who did not have mobile phones of their own, to talk to or "Facetime" their family, using the mobile phones of ward staff?

30) If yes, was a directive to this effect issued for ALL the wards in the hospital?

31) If no, why was it not considered important that patients' relatives be allowed to communicate with their loved ones who were essentially isolated on the wards during the start of the pandemic?

32) If a patient disagrees with the decision to discharge them, and refuses to be discharged, what is the procedure followed by the hospital, assuming the patient is compos mentis and able to understand the implications of their actions?

33) If the next of kin of a severely demented elderly patient objects to their loved one being discharged, what is the procedure followed by the hospital? In the above instance is the hospital permitted to go ahead and discharge the patient without consulting with the wife and children of the patient (the next of kin)? In the above instance, does the hospital notify the relatives that they will be discharging their loved one regardless, and also notify them in advance (with at least 24 hours notice) of the date and time of discharge?

34) For Qs 32 and 33, has the standard procedure changed intra-pandemic and/or post-pandemic, from what it was PRE-pandemic? Or has it remained essentially the same?

35) If a patient's relative were to call and ask to speak to a member of the medical team in charge of their loved one's care, are doctors obliged to take their call and explain the nature of the treatment being given? Can a doctor decline to discuss a patient over the phone and insist that only face to face consultations will be entertained (e.g. when the patient's wife is elderly and cannot drive and lives too far away to go to the hospital)? What is the guidance issued by the General Medical Council with respect to doctors' duties in this regard?

Yours faithfully,

Reverend Mark Paul

uhcw@infreemation.co.uk, University Hospitals Coventry and Warwickshire NHS Trust

 
University Hospital
Clifford Bridge Road
Walsgrave
Coventry
CV2 2DX

Direct Line: 024 76968771
www.uhcw.nhs.uk

 

Dear Requester

We acknowledge receipt of your email to UHCW:

Freedom of Information Request Form

If you have submitted a request under the Freedom of Information Act
(FOIA) your request will be considered and you will receive our response
within the statutory timescale of 20 working days.

The reference number for your email is FOI/2551.

Should you have any further inquiries concerning this matter, please reply
to this email leaving the subject line unchanged.

Yours sincerely,
UHCW

uhcw@infreemation.co.uk, University Hospitals Coventry and Warwickshire NHS Trust

 
University Hospital
Clifford Bridge Road
Walsgrave
Coventry
CV2 2DX

Direct Line: 024 76968771
www.uhcw.nhs.uk

 

Dear Mark

I write further to your recent Freedom of Information request.

Unfortunately it is taking longer that the usual 20 working days to
provide response to your request; can I therefore respectively ask for an
extension of an additional two weeks in which to provide our response to
you?

Thank you for your patience is this matter.

Kind regards

Heidi

uhcw@infreemation.co.uk, University Hospitals Coventry and Warwickshire NHS Trust

1 Attachment

 
University Hospital
Clifford Bridge Road
Walsgrave
Coventry
CV2 2DX

Direct Line: 024 76968771
www.uhcw.nhs.uk

 

Our Ref: FOI/2551
Date: 16 June 2023

By email only

 

Dear Requester

We write further to your request for information under the Freedom of
Information Act received 27 March 2023.  We have set out your request,
together with our response below. 

I would like the answers for EACH question PRE-pandemic AND POST-pandemic.
In short, if the procedure has remained the SAME both before AND after the
start of the pandemic, please say so.

If there have been CHANGES or DIFFERENCES introduced in the standard
operating procedure after the start of the pandemic, kindly indicate this,
and state WHAT the changes are.

1) What is the standard procedure you follow when discharging in-patients
from hospital? - See attachment

2) Who decides when it is time for the patient to be discharged? - See
attachment

3) Is the decision to discharge taken purely by the medical team in charge
of the patient's care, or is it influenced by the managers, depending on
bed availability? - See attachment

4) Is there a discharge team who coordinates discharges from hospital? -
See attachment

5) Is this discharge team the SAME for EVERY ward in the hospital, and for
every speciality, or is there a SEPARATE discharge team for each ward
and/or speciality? - See attachment

6) What qualifications do the members of the discharge team hold? For
example, are they former nurses, technical staff, managers, what? - See
attachment

7) Who were the members of your discharge teams for Orthopaedic surgery,
Geriatrics, and Internal Medicine, for the years 2018, 2019, 2020, and
2021? - See attachment

8) Whose responsibility is it to apprise the patient, and/or their next of
kin, of the decision to discharge? Is it the responsibility of the
discharge team, the medical team, or both? - See attachment

9) Who are the current members of your various Discharge teams? - See
attachment

10) If the patient is a minor, or they are an elderly patient with
advanced dementia who does not have the mental capacity to comprehend
discharge decisions, does the discharge team, or the medical team, or
both, hold discussions with the next of kin or family members, regarding
the decision to discharge? - See attachment

11) If such discussions are held with the next of kin, who are they by?
The discharge team, the medical team, or both? - See attachment

12) Are there any circumstances under which the standard operating
procedure that governs hospital discharges is bypassed, and not followed?
If so, what are those circumstances? - See attachment

13) Are there any circumstances under which the next of kin of the patient
are not informed about the decision to discharge, and a discharge goes
ahead without their knowledge?
If so, what are those circumstances? - See attachment

14) Are there any circumstances under which a discharge to the community
goes ahead without the consent of either the patient, or their next of kin
(in the case of patients with advanced dementia)? If so, what are those
circumstances? - See attachment

15) What are the guidelines and strictures issued by the General Medical
Council, the regulatory body for doctors, with respect to hospital
discharges and how they are conducted for patients who have capacity, and
for patients who are either minors or lack capacity (e.g. elderly patient
with advanced dementia)? - See attachment

16) Is there a similar code that has to be followed by the non-medical
members of the team, such as managers? - See attachment

17) Does the General Medical Council stipulate that doctors have to be
actively involved in holding discharge discussions with either patients or
their next of kin, prior to discharge? - See attachment

18) Do all NHS hospitals in the 4 countries that comprise the United
Kingdom (England, Wales, Scotland, and Northern Ireland) follow the exact
same discharge process, or does it vary from Hospital Trust to Hospital
Trust and/or Country to Country (for e.g. does Wales follow different
guidelines from England)? - See attachment

19) Has there ever been an instance of a patient getting discharged from
hospital without discussions first being held with either the patient, or
the next of kin (if the patient has advanced dementia), and if so why did
this occur? - See attachment

20) Have there been significant changes in discharge procedures after the
start of the pandemic? If so, what are the changes? Have these changes, if
any, been reversed now, or are they ongoing? If ongoing, how long will
they continue? - See attachment

21) WHEN, WHY and by WHOM was the decision to prevent patients' relatives
from visiting them on the wards taken, at the start of the pandemic? - See
attachment

22) Was this decision taken by the top managers at the hospital, or was
this a directive issued by the Department of Health and Social Care? If
the latter, was it simply "guidance" or a rule that had to be strictly
enforced? - See attachment

23) Was this decision implemented nationwide, or was it down to individual
hospitals to decide for or against imposing it on their patients? - See
attachment

24) Is the above rule (about no visitors) ongoing or can patients'
relatives now visit their loved ones on the wards? - See attachment

25) During the time that no visitors were permitted, were the loved ones
and next of kin of patients who were being discharged allowed to see them
either just BEFORE or DURING discharge, if aforementioned patients were
not being discharged to their own homes (e.g. they were returning to a
Nursing Home)? - See attachment

26) If yes, did the hospital or discharge team notify patients' next of
kin of the impending discharge, with at least 24 hours notice or more, to
give the relatives time to get to the hospital and see their loved ones
prior to them being sent back to their Nursing home (given that no
visitors were allowed into Nursing homes once the pandemic started)? - See
attachment

27) If no, why were relatives not given the chance to see their loved ones
at least briefly prior to discharge, given that they would then NOT be in
a position to visit them in their Nursing Homes for a period of several
months at least? - See attachment

28) During the time that no visitors were allowed into wards, did ward
staff ensure that relatives and next of kin were kept informed of every
aspect of their loved ones' care and progress? If so, how did they do
this? - See attachment

29) During the time that no visitors were allowed into wards, did ward
staff ensure that relatives were still able to communicate with their
loved ones via telephone? Was an attempt made to permit bed-bound
patients, in particular those elderly patients who did not have mobile
phones of their own, to talk to or "Facetime" their family, using the
mobile phones of ward staff? - See attachment

30) If yes, was a directive to this effect issued for ALL the wards in the
hospital? - See attachment

31) If no, why was it not considered important that patients' relatives be
allowed to communicate with their loved ones who were essentially isolated
on the wards during the start of the pandemic? - See attachment

32) If a patient disagrees with the decision to discharge them, and
refuses to be discharged, what is the procedure followed by the hospital,
assuming the patient is compos mentis and able to understand the
implications of their actions? - See attachment

33) If the next of kin of a severely demented elderly patient objects to
their loved one being discharged, what is the procedure followed by the
hospital? In the above instance is the hospital permitted to go ahead and
discharge the patient without consulting with the wife and children of the
patient (the next of kin)? In the above instance, does the hospital notify
the relatives that they will be discharging their loved one regardless,
and also notify them in advance (with at least 24 hours notice) of the
date and time of discharge? - See attachment

34) For Qs 32 and 33, has the standard procedure changed intra-pandemic
and/or post-pandemic, from what it was PRE-pandemic? Or has it remained
essentially the same? - See attachment

35) If a patient's relative were to call and ask to speak to a member of
the medical team in charge of their loved one's care, are doctors obliged
to take their call and explain the nature of the treatment being given?
Can a doctor decline to discuss a patient over the phone and insist that
only face to face consultations will be entertained (e.g. when the
patient's wife is elderly and cannot drive and lives too far away to go to
the hospital)? What is the guidance issued by the General Medical Council
with respect to doctors' duties in this regard? - See attachment

As we have provided the information that we do hold your request is now
closed.  We trust that this is satisfactory but if you are dissatisfied
with the way that it has been handled you have the right to ask for an
internal review.  Internal review requests should be submitted within two
months of the date of receipt of the response to your original letter and
should be addressed to: David Walsh, Director of Corporate Affairs,
University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge
Road, Coventry CV2 2DX.

If you are not content with the outcome of the internal review, you have
the right to apply directly to the Information Commissioner for a
decision.  The Information Commissioner can be contacted at: Information
Commissioner’s Office, Wycliffe House, Water Lane, Wilmslow, Cheshire, SK9
5AF.

Yours sincerely

 

 

 

Andrea Phillips
FOI & Access to Health Records Manager

We don't know whether the most recent response to this request contains information or not – if you are Mark Paul please sign in and let everyone know.