Hospital discharges delayed by unnecessary checks

Denis Gizzi, Chief Officer of Greater Preston CCG, says one elderly patient was kept in hospital for a month for a urine infection.
Denis Gizzi, Chief Officer of Greater Preston CCG, says one elderly patient was kept in hospital for a month for a urine infection.
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Almost a third of the actions taken during the treatment of patients in the urgent and emergency care system in central Lancashire are unnecessary, according to a new analysis.

The figure is revealed in a report commissioned as part of a plan to review the service before winter.

A board meeting of Greater Preston’s Clinical Commissioning Group (CCG) was told that the current way of working led to variability in patient experience.

Denis Gizzi, Chief Officer for Greater Preston CCG, said: “If you have two elderly patients with similar conditions in beds next to each other, then you wouldn’t do fundamentally different things [to treat them]. But that’s exactly what happens every day.”

He recounted the case of a pensioner with a urinary tract infection who should have been able to leave hospital after three days, but was delayed by assessments for therapy. The patient ended up in hospital for 31 days and, after their condition deteriorated, they ultimately had to go into a care home.

Dr. Brigid Finlay, a GP in Preston, said that a consultant should have been asking questions in that particular case.

But Ian Cherry, lay member for finance on the committee, said patients were often “parked in inappropriate beds” and could become overlooked.

The analysis of patient journeys took place over four days in May and examined all routes through the urgent and emergency care system.

It found that 30 percent of ‘steps’ in the patient pathway were “non-value added”, while another 33 percent did not directly benefit the patient, but were deemed necessary.

Staff time was found not to have been used effectively and there was a lack of clarity over responsibilities.

Jayne Mellor, Director of Delivery at Greater Preston CCG, said those working on the frontline were not at fault. “In defence of staff, we have put policies and procedures on top of each other,” she said.

Ms. Mellor added that a patient’s stay in hospital could be lengthened by multiple assessments before they were discharged.

Denis Gizzi warned that unless there was a significant change to the most pressurised points in the service within the next 10 weeks, “this winter will be as bad as last - if not worse”.

The report concludes that processes need to be standardised, with treatment becoming “truly patient-centred”. It adds that “everybody should be trusted to do a good job”, thereby removing the need for “just in case checks”.