Data briefing: what affects same-day discharge rates?

Over recent years there has been a growing trend in the number of non-elective patients discharged on the same day as they were admitted.

This has to be seen as positive for patients and hospital efficiency. The first chart shows this trend for the whole UK, using data from the CHKS comparative database from clients across England, Wales, Scotland and Northern Ireland from 2001. Annual increases have been 9-18 per cent, significantly higher than the rate of increase of non-elective patients overall (around an annual 6 per over the last the past three years).

It is likely the four-hour accident and emergency target may have caused the admission (and rapid discharge) of patients who previously would have received all treatment in A&E. Another possible factor is changes in the admission process for non-elective patients. Increasingly, hospitals have set up admission or receiving units for both medical and surgical patients to ensure the sickest patients are seen more quickly by experienced consultants.

Looking at the data on a daily basis shows a small increase in the proportion of same-day discharges every Friday. Look at the data over a five-year period and a much more remarkable issue became apparent, with an obvious peak every Christmas Eve.

People prefer not to be admitted for Christmas and doctors prefer to keep them out of hospital. However, to discharge so many (8-10 per cent more than the annual average daily rate) just because it is Christmas Eve implies the discharge criteria have been altered.

Other factors, such as the relatively quiet workload in outpatients on Christmas Eve, may allow for diagnostic services to provide a speedier response for non-electives patients, but it is unlikely that this would explain such a remarkable change.

The increased rate could be due to poor medicine and rushing through the workload on the day. We examined readmission rates to see if there was any correlation, but there is no evidence to imply that the additional patients sent home on Christmas Eve are any more likely to require readmission. The important question is whether this performance could be achieved at other times. Achieving only half this increase would produce a significant reduction in bed demand. Assuming patients would have otherwise been admitted for only one night still means 5 per cent fewer non-elective beds occupied.

Paul Robinson is marketing director for healthcare information provider CHKS (phone 01789-761600 or go to www.chks.co.uk).