Issue three: Relatives and carers not being told that their loved one has been discharged
Almost all of the cases we saw highlight failings in communication between clinicians and patients' families. The knowledge that a loved one has been sent home alone and experienced potentially avoidable suffering is extremely distressing for relatives.
Department of Health guidance is very clear that carers should be involved in all stages of the discharge planning process, given good information and helped to make care planning decisions and choice.13
A hospital transferred a distressed elderly woman to a nursing home and only informed her family a few hours before her discharge
Miss G was admitted to hospital in winter after a fall. She stayed in hospital until early spring the following year, when she was discharged to a nursing home. Miss G initially refused to be discharged. The Trust did not tell any members of Miss G's family about its decision to discharge her until the morning of the day she was to be discharged. She was agitated when an ambulance arrived to take her to a nursing home. Eventually she calmed down and agreed to leave hospital in the ambulance. Miss G was discharged in a disheveled state with a cannula (tube) still in her arm.
What we found
The hospital did not respond appropriately to Miss G's initial refusal to be discharged. The staff should have tried to persuade her to leave, and raised the matter with a doctor or senior member of staff. Instead, a nurse inappropriately said something to the effect of: 'Miss G still has to be discharged'. Staff should have told the family about the decision to discharge Miss G before it happened.
Miss G was discharged in a disheveled state with a cannula (tube) still in her arm.'
85-year-old woman with dementia was sent home despite being unable to look after herself or get to the toilet
Mrs K, an 85-year-old woman who suffered from dementia, was taken to hospital after she experienced vaginal bleeding. Following examinations and blood tests, the hospital sent her home.
Mrs K was transferred to the acute medical unit to wait for an ambulance. An ambulance was booked at 8.48pm; Mrs K's medical notes showed this was before she had expressed her preference to go home. It arrived at 11pm. Although the hospital had been unable to reach Mrs K's son to let him know that they planned to discharge his mother, it let Mrs K go home.
The following morning Mrs K's daughter, Mrs G, visited her at home. She found that her mother had been left with no food, drink and bedding, unable to care for herself or get to the toilet.
What we found
While Mrs K may have been medically fit to be discharged, the hospital failed to consider whether it was safe to send her home when it did. There was no evidence that as part of its decision, the hospital had considered whether Mrs K's home was an appropriate environment to send her back to. We also found that the hospital failed to make sure that appropriate care was available to Mrs K when she arrived home.
Although Mrs K wanted to go home, and had the capacity to decide to leave hospital, by sending her home in an ambulance at 11pm the hospital failed to act in line with its own policy of not discharging older patients after 10pm. The decision to discharge also appeared to have been reached before discussions about this took place with Mrs K. In addition, when the hospital was unable to reach Mrs K's son to inform him that his mother was being discharged, it did not then attempt to contact her daughter – even though her contact details were also available in Mrs K's clinical records.
Considering these factors, we found that the decision to discharge Mrs K was inappropriate, and that the hospital failed to take the right steps to safeguard a vulnerable patient. This led to Mrs K being discharged without the support she needed.
She found that her mother had been left with no food, drink and bedding, unable to care for herself or get to the toilet.'
13 Department of Health (2010), Ready to go: Planning the discharge and transfer of patients from hospital and intermediate care.