Method to the Madness?
So, after being pressured into discharging patients as soon as possible, hospitals are now to be fined if patients have to be readmitted. Is there method to this madness? You decide:
08 June 2010
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14 comments:
From getting slung out early to free up beds it will now be difficult to get readmitted if necessary. At least that is the logic. In my limited experience doctors, especially GPs, are more interested in a patients needs so perhapsd it will be alright.
And what about the DKA's who we can see in A&E sometimes as often as twice a week who are correctly discharged then come back in due to self neglect. Is this going to be the hospitals fault?
I would fine the OOH service which sends patients in who should have been left where they were in their nursing home. In the days when GPs looked after their own patients all day and all night this happened much more rarely.
Doesn't this force decisons to be based upon informed medical/clinical judgement rather than a management issued checklist?
If so, then it could be a step in the right direction. Give control back to medically qualified people.
Ray.
I agree with Ray. Those of use who have been goaded, some might say bullied, into discharging patients earlier than we are professionally comfortable with will welcome this as we can use it as a stick to beat the managers.
There is clear evidence that as we have been forced to discharge patients more quickly readmission rates have shot up.
The managers should just have left the whole thing to our professional judgement but, since they did not, this does, to some extent, put more power back where it belongs in the hands of the consultant.
I have never seen the point of fines for public authorities, it merely makes things worse for those who have suffered causing the fine in the first place.
This is an approach which can be used with private hospitals which are profit making and need the fees to keep going, but an NHS hospital can't be allowed to go broke!
The problem is Ray that management will now try to prevent the readmision of a patient inside 30 days. The solution is not another target but removing none medical management, or at least reduce them to an advisory role with no powers.
"No, it is utter nonsense"
- JD
The only bit that makes sense to me, after accidentally encountering the managers in the acute Trust, was their musings and smoke & mirrors in their Dark Arts of Finance.
They get paid by activity. If they admit someone, sort out an episode of care, discharge 'em and get paid, then they're admitted 10 days later, say, they've another episode of care and more income. Ker-ching.
This policy will stop Trusts turfing people out, on the premise that if they get it wrong the GP can always bounce them back in again (with the patient then getting hospital care and the hospital getting the cash of another FCE).
Clinically, it's utter nonsense. but to reign in dubious financial mangement Dark Arts practitioners, it tragically makes a perverse kind of sense to me . . .
Just a word for nursing homes, Anonmynmous 07.58. They get hammered if they call out the GP too much. they get hammered if they dont call out the GP early enogh. Ditto process with sending people into hospital. I spend half my working life in meetings where nursing homes are called to account for doing all these things.
Some relative think their aged parent should live forever and will insist that they are sent into hospital when really they should get high quality nursing care and be allowed to pass away peacefully in their beds. The home then gets criticised by the PCT which is cross that it has paid for premium end of life care.
Soon there will be noone at all who is willing to do this thankless work. Already it is virtually impossible to get UK nurse to work in nursing homes - they are recruited en masse by VOIP from abroad, are dumped into a system they do not understand and then expected to manage stroppy middle aged care assistants.
Sorry if gone off topic but there is a big crisis coming here.
As to the question, I agree this will just make it nigh on impossible rather than just very difficult to get an old person readmitted, more stress for everyone in the system including the poor old informal carer.
I can't make up my mind about this. Andrew Lansley's emphasis seems to be on 'care in the community' here rather than an extended one stop stay in hospital to make sure the condition clears up. If this leads to longer stays in hospital so that the patient doesn't need to be re-admitted, well and good. If it leads to people being turfed out early and not being readmitted, but 'supported in the community, then we're going to have the worst of all possible worlds. It means that aftercare is going to be shifted to the much smaller local authority pot and then the government can play the 'we want these people to be properly looked after, but these dastardly councils won't fund it' nonsense. I'm going to wait and see on this one..
Hopefully none of this will apply in remoter areas. NHS Trusts could learn from models where the GPs are in touch with consultants by phone when necessary. I get so confused by all the gobblede-admin-piffle and creating a climate of blame before you start is hardly conducive to the principle of active responsibility of all concerned.
In haematology, patients are discharged with the expectation that they might be readmitted as emergencies. We could kep them in hospital for the whole of their recovery period after chemotherapy, but that would be unfair and oppressive. Instead we discharge them under strict instruction to return if they get a fever, since they need immediate intravenous antibiotics. Perhaps we should call these planned, though indeterminate, admissions.
That's an excellent point, Terry. And it applies to all sorts of conditions. This really hasn't been thought through.
I do hope you are feeling OK. I remember you well from when I worked in Bournemouth for an excellent physician whose first name was Justin.
Agree with anonymous 12.58 - there are many cases where relatives say 'everything must be done' when informed that their aged relative is ill. And what about all those people who have 'risky discharges' home because of dementia, falls etc where the patient wants to go home and the family want us to at least have a try - shall we stop giving them a chance to try to cope at home with support and just put them all in locked rest homes? (Even if we wanted to do that, social services wouldn't allow it)
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