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Children put at risk by Government’s early discharge drive

By Ian Quinn

Children are being put at risk by hospitals which discharge them too quickly, according to a report raising fears over the safety of the Government's drive to cut bed days.

Researchers from the University of Manchester uncovered evidence that children under 15 were far more likely to be re-admitted to hospital if they are discharged within a day of admission.

It follows previous Pulse reports showing GPs are being swamped with extra work because of hospitals' early discharge policies.

The study involved analysing data from more than 40,000 young patients with common conditions such as breathing problems, fever and diarrhoea at 12 hospitals in the north west of England in from2005/6 to 2006/7.

Rates of children being discharged on day one were as high as 85% in one hospital. Of the 1,273 readmissions within 28 days, more than 80% had been in hospital for less than a day.

Lead researcher Professor Peter Callery, chair in children's nursing at the University of Manchester, said there was ‘clear association between readmission rates and same day discharge'

‘With earlier discharge there is more potential for a child's underlying condition or complications to develop and so require readmission,' he said.

The report also found evidence that the busiest hospitals had the highest rates of same day discharge, concluding: ‘Clinical staff in busier hospitals may be working under greater

pressure leading to more inappropriate early discharges.'

The report will be published in the Archives of Disease in Childhood next month, just as trusts finalising plans for massive cutbacks in hospital spending, with NHS London alone planning to save £2.5bn from measures including slashing bed days.

Senior NHS managers have started to publicly admit there is a link between early discharge and readmissions.

In its commissioning framework for 2010/11, NHS East of England says payment by results charges for non-elective readmissions have shot up by more than £27m in the past two years.

‘Capacity pressures relating to emergency admissions and 18 weeks [target] can result in poor quality discharges, which carry a risk of patients needing readmission.

‘An indicator of poor discharge processes is the level of patients readmitted under the same specialty within 28 days of discharge.'

The trust is planning to introduce thresholds for re-admissions, over which hospitals would not be paid.

Las week the Conservatives promised to bring in a similar policy across the country as it released figures showing the number of patients readmitted as emergencies within 28 days of being discharged rose from 359,719 in 1998-1999 to 546,354 in 2007-08.

Dr Dermot Ryan, a GP in Loughborough and a member of the research committee of the General Practice Airways Group, said:

‘The whole chain of command in hospitals is very, very weak and its being driven by the expediency of getting people out as quickly as possible because trusts don't want to pay the money.'

Children put at risk by Government's early discharge drive


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