A growing number of patients are being readmitted to hospital as emergency cases within days of being discharged, raising fears that hospitals are so busy and understaffed that they are providing inadequate care.
The number of patients who have to be taken back into hospital in England within 30 days rose 19.2% from 1.16 million in 2010-11 to 1.38 million in 2016-17, according to a report by the Nuffield Trust and Health Foundation thinktanks.
The findings have prompted concern that hospitals are discharging some patients too soon, that warning signs about patients’ conditions are being missed, possibly because staff are so busy, and that staff are dealing with patients who should not need to be there.
Medical leaders have voiced unease at the findings, particularly that almost 200,000 patients a year are having a second spell in hospital because staff failed to spot they had a blood clot, pneumonia or pressure sores. Researchers identified those three conditions as a source of acute concern because they are all preventable, as long as the patient receives the right care, either in or outside hospital.
The number of patients readmitted as a result of those illnesses grew over the same period, from 130,760 to 184,763 – a rise of 41.3%. Readmissions with pneumonia rose by 72.5%, while those involving pressure sores almost trebled and those for venous thromboembolism (blood clots) were up by a third.
“Unnecessary trips and overnight stays in hospital put a strain on elderly patients and their families. That’s why it’s concerning that our research shows the number of people being readmitted to hospital within 30 days with potentially preventable conditions is greater than it was seven years ago”, said Prof John Appleby, the Nuffield Trust’s director of research.
Dr Nick Scriven, the president of the #Society for Acute Medicine, warned that some patients were paying the price – through an increased risk to their #health – of understaffed and under-resourced hospitals sometimes not being able to cope with the number of severely ill patients who need care.
“Each readmission is a tragedy for the individual concerned in that it further puts them at risk of declining health in a downward spiral and in my view is often a consequence of units and individuals being totally overstretched by demands on them,” said Scriven, whose members are hospital doctors specialising in acute medicine.
But beds in NHS community hospitals are now so few that patients are not getting the right care once they are discharged, he added.
“Sometimes we have to acknowledge that we need to keep patients in hospitals longer than we would hope, to give them a chance to recuperate enough not to need a readmission. This is where community care should be picking up the load and really we would ideally rethink the now almost total lack of community beds.”
Donna Kinnair, the Royal College of Nursing’s director of nursing, policy and practice, said the #NHS-wide shortage of nurses was a key factor.
“These findings reflect the impact 40,000 nurse vacancies has on patient care. Nurses want to do the best they can for their patients, but with hospitals struggling to recruit and shifts left unfilled, there are too few nurses to deliver the best care. Patient mortality rises and falls with the number of nurses on duty,” said Kinnaird.
Dr Chaand Nagpaul, chair of the council of the British Medical Association, said: “Bed occupancy across the country is still staggeringly high and way above levels considered safe. A chronic lack of resourcing is entirely to blame and with so few beds available, patients could end up being discharged before they’re fully ready to leave. A lack of district nurses and social care means that patients are also being discharged without enough support in home settings.”