In court with the Mid Staffordshire NHS Trust.

The Mid Staffordshire Hospital scandal continues; The health and safety executive are now prosecuting the Health Authority for some of the most blatantly negligent of the 600 odd deaths caused by poor staff and management at this nightmare group of hospitals.

Except it is being wound up and effectively a 'legal body' is being taken to court when it should have been the management and those directly responsible.

This would be just a farce except one of the deaths occurred last year - long after the scandal was exposed, the official report was published and  a 'new' trust created to take over.

You can read about Mid Staffs and The Francis Report on the archive pages of this Blog.

This is from The Daily Telegraph;

Sponsored

 

Mid Staffordshire NHS Foundation Trust charged over four deaths

The trust at the centre of the worst ever NHS scandal is facing criminal charges over the deaths of four patients

 

     

By Laura Donnelly, Health Editor

15 Oct 2015

The trust which ran Stafford Hospital is to face criminal charges related to the deaths of four patients - one as recent as last year.
 

The Health and Safety Executive (HSE) has brought charges against Mid Staffordshire NHS Foundation Trust over the deaths of four elderly patients between 2005 and May 2014.

Mid Staffordshire NHS Foundation Trust was at the centre of one of the biggest scandals to hit the health service over the deaths of hundreds of patients, amid appalling failings in care.

The HSE said the charges related to the deaths of Patrick Daly, aged 89, who died in May 2014, Edith Bourne, aged 83, who died in July 2013, Ivy Bunn, aged 90, who died in November 2008, and Lillian Tucker, aged 77 who died in October 2005.

Mrs Tucker died after a junior doctor gave her a penicillin-based drug despite being told she was allergic to the antibiotic, an inquest heard. She had suffered fall, which led to a small fracture while on a family holiday in the area.

His son later said he "would not touch the hospital with a barge pole" after detailing the family's repeated warnings about his mother's allergy.

The HSE said it had charged Mid Staffordshire NHS Foundation Trust following a "thorough and comprehensive investigation into the circumstances of four deaths of patients under its care".

The trust is due to appear before Stafford Magistrates on November 4. A new trust began to run the hospital last November.

Last week police and health officials said they are investigating claims of an NHS “cover-up” over the death of a three-year old boy, Jonnie Meek, at Stafford Hospital, last year.
 
The parents of Jonnie Meek, who died at Stafford hospital, say failings were covered up .

This probe will check claims that statements from health workers who witnessed his death were falsified.
It is very rare for the HSE to act in cases involving clinical failings, and the body has previously been criticised for its reluctance to prosecute.
 
The Mid Staffs inquiry accused the body of “looking for reasons for not taking action rather than starting from a consideration of what is in the public interest. “
 
“The more serious and widespread a failure is, the less likely it is that the HSE will decide to intervene, even where it is apparent that no other regulator is likely to do so,” Robert Francis, the chairman of the inquiry said.

Last year the same trust was fined £200,000 over the death of Gillian Astbury, 66, who died in 2007 because nurses at Stafford hospital failed to give her the routine insulin she required to stay alive.
Wayne Owen, HSE principal inspector in the West Midlands, said: "We have concluded our investigation into the death of four patients at Stafford Hospital and have decided there is sufficient evidence and it is in the public interest to bring criminal proceedings in this case."

The trust remains in place as a legal entity but no longer provides patient services.
University Hospitals of North Midlands NHS Trust took over the running of Stafford Hospital and Royal Stoke University Hospital.

The Mid Staffs special administrator Tim Rideout said the remaining "shell organisation" would oversee any "potential criminal liabilities".
He added: "I am committed to bringing matters to a conclusion as efficiently and effectively as possible in the best interests of the families concerned.

Neil Harris
(a don't stop till you drop production)

Home: helpmesortoutthenhs.blogspot.com

Contact me: neilwithpromisestokeep@gmail.com

 

Safety staffing levels to be ignored.

NHS 'backtracking' on ward nurse numbers introduced after Mid Staffs

Critics fear safety will be sacrificed to cut costs after NHS bosses tell hospitals that 1:8 nurse-to-patient ratio is a guide, not a requirement

 

Denis Campbell

Health policy editor

Tuesday 13 October 2015 

 

  

The NHS has been accused of backtracking on improvements in patient safety made after the Mid Staffs scandal by reducing the number of nurses on wards because of its growing financial crisis.

NHS bosses have told hospitals they no longer have to ensure that one nurse is caring for no more than eight patients at a time, in order to help tackle a £2bn black hole that has left 80% of hospitals facing deficits of up to £100m each.
The letter states: “We would stress that a 1:8 ratio is a guide not a requirement. It should not be unthinkingly adhered to. Achieving the right number and balance of clinical and support staff to deliver quality care based on patient needs in an efficient way that makes the best possible use of available resources is the key issue for provider [hospital] boards.
 
 
The move, set out in a letter to all hospital chiefs, has sparked fears that patient safety will be sacrificed to help hospitals cut costs. It makes clear that financial considerations are deemed to be as important as the safety and quality of care patients receive when deciding how many nurses should be on duty.

Cash-strapped hospitals may be tempted to cut their nurse staffing levels as a result of the new advice, the Royal College of Nursing (RCN) warned. Staffing takes up 70% of the NHS’s budget and its bill for employing temporary staff to plug gaps in rotas, especially expensive agency nurses, has hit £3.3bn in the last two years.

The letter has been signed by NHS England, the Care Quality Commission, the National Institute for Health and Care Excellence (Nice), and the regulator NHS Improvement. It recommends that hospitals can ask health professionals, such as physiotherapists, to help look after patients, and use technology to monitor their condition, to reduce the need for nurses on duty.

It urges hospitals “to take a rounded view of staffing” that shows they are “making the best use of resources” as well as providing safe care. It lists a set of variables, including how ill patients are, and then adds: “In some cases these factors will mean a higher number of nurses per patient, and in other cases it will mean a lower number or different configuration of staff can be justified.”

It adds: “It is therefore important to look at staffing in a flexible way which is focused on the quality of care, patient safety and efficiency rather than just numbers and ratios of staff.”

NHS facing £2bn deficit and 'worst financial crisis in a generation'

Hospitals have overspent by nearly £1bn in three months due in part to soaring bill for agency and other temporary staff, according to regulators. 

           

The NHS is under heavy pressure from ministers to make £22bn of “efficiency savings" by 2020 to help plug the £30bn gap expected to have developed in its finances.
The new advice is a substantial downgrading of guidelines produced only last year by Nice, which insisted that no nurse should look after more than eight patients to ensure good, safe care. That ratio was widely hailed as a way of avoiding a repeat of the Mid Staffs scandal, in which a lack of nurses was found to be a key cause of the appalling care.

Howard Catton, the RCN’s head of policy, said: “There’s a risk that people in the NHS may interpret this letter as a green light to row back on safe staffing when the NHS’s finances are in the perilous state that they are.”

However, he added that other suggestions in the letter, such as allowing hospital managers to use their professional judgment about how many nurses were needed and not rigidly applying fixed ratios, were “common sense”.

Labour said the NHS circular showed that patient care could be put at risk as a result of the fast-ballooning deficit.
“The idea that hospitals can ignore safe-staffing guidance will alarm patients. Safe staffing levels are essential for patient safety and were a key recommendation of the Francis report,” said Heidi Alexander, the shadow health secretary.
“If ministers attempt to balance the books in the NHS by cutting staff and putting patients at risk, then Labour will oppose them all the way. It is yet further evidence that the financial crisis in the NHS is now a real threat to patient care.”

Analysis Is NHS being overcharged by agencies – or are staff shortages the real issue?

Health secretary Jeremy Hunt is bringing in curbs on the use of employment agencies in the health service, but is he missing the point?            

            

Ian Wilson, chair of the British Medical Association’s representative body, said: “Adequate staffing levels are vital to deliver safe, high-quality patient care. Flatline funding at a time of rising demand has left services and the frontline staff who deliver them under enormous pressure. The solution is not to stretch existing staff even further, but to ensure the NHS has the resources needed to deliver safe care.”

But hospital bosses welcomed the move away from the 1:8 ratio. “NHS England boss Simon Stevens deserves credit for persuading Jeremy Hunt to soften his previous hard line on safety at any cost. We need to be pragmatic in the face of spiralling deficits,” one told the Guardian .
“It will give more discretion to senior nursing colleagues, giving them a vote of confidence. A ‘one size fits all’ is not the solution to staffing levels; it is about empowering frontline leaders.”
Canadace Imison, director of healthcare systems at the Nuffield Trust thinktank, said: “This letter shows a welcome attempt by NHS regulators to deliver a consistent message about safe staffing levels. It also rightly recognises that the 1:8 nurse to patient ratio is a crude metric and not to be seen as a benchmark.”

But it also leaves NHS trusts no wiser about whether they should under-staff or overspend in order to provide high-quality care, Imison added.

                                ----------//----------

This article in today's 'Guardian' is very worrying; we spent two years analysing the appalling mistreatment of patients at Mid Staffordshire Hospitals and the long awaited official report made clear (among many other recommendations) that a minimum of one nurse to 8 patients was an absolute requirement.

This was endorsed by N.I.C.E. and the other regulatory bodies.

Now that money is short?

Forget it.

All the studies show that patient safety and outcomes are worse when there are too few nurses to patients. We came to this conclusion years after other advanced countries.

For some reason, we have historically trained too few nurses and doctors and there is always a shortage.

Secondly, there is a historic reluctance to accept that too few staff is dangerous.

Neil Harris
(a don't stop till you drop production)

Home: helpmesortoutthenhs.blogspot.com

Contact me: neilwithpromisestokeep@gmail.com 
 

Hospital Discharge - a silent scandal.

This is a BBC report dealing with a survey into the discharge of patients from NHS hospitals. It follows perhaps 15 years where hospitals have been pressured (a pressure they have largely been delighted with) to discharge patients as soon as possible.

 

The result is that decade on decade, hospital admission periods have been falling, with a corresponding saving of money and a theoretical increase in the number of beds available.

 

Except that over the same period, the number of beds has been falling which means that the savings have just been used to reduce costs and not to increase operations.

 

The problem? Readmissions following discharge have been growing too - it's making people ill sending them home too early.

 

The answer? A low dependency ward with reduced staffing for another days convalescence.

 

Because sending elderly people home too soon increases the number of Accident and Emergency admissions when it all goes wrong.

 

Here's today's BBC report (21/7/15); 

 

The way hospitals discharge patients is probably contributing to high levels of readmission, a year-long Healthwatch England inquiry has found.

 

It said many hospitals failed to notify relatives or check patients had any accommodation before discharging them.

The watchdog looked at data from Freedom of Information requests, patient surveys and more than 3,000 patient reports to its local teams.

Anna Bradley, who chairs Healthwatch England, called some of it "shocking".
"There is a huge human and financial cost of getting discharge wrong," she added.

One report said an 81-year-old stroke survivor had been sent home in a taxi while his wife was told he was being transferred to a rehabilitation centre.

Another involved a young man with severe mental health problems who had been discharged with no consultation with his psychiatrist and no treatment.

Of the 120 hospital trusts that responded to Freedom of Information requests:

• half were failing to record whether the patient's home environment was suitable
• a third were failing to record whether the patient's GP or carer had been notified of new medicines

In 2014, the National Audit Office reported the NHS saw a million readmissions within 30 days of discharge, costing an estimated £2.4bn a year.

A spokesman for NHS England said hospitals should be making sure patients are appropriately discharged.

"We need to ensure appropriate care is put in place before a patient leaves hospital which needs strong joint working across the health service."

Neil Harris
(a don't stop till you drop production)

Sorry about the gap since I last Blogged - I was checking hospital facilities at first hand - I broke my back.

If you want to know what is going on you can check out my other Blog on;

helpmesortoutstpeters.blogspot.com

Home:  helpmesortoutthenhs.blogspot.com
Contact me: neilwithpromisestokeep@gmail.com 

The real NHS Cuts behind the Tory figures.

This article has been ignored by the British press during the election campaign; it was published on the RT website but it’s a Reuters article.

The two main health service unions have commissioned a study into what the NHS pays hospitals for the operations they carry out (that’s where most of their income comes from).

When the Tories tell us how well off the NHS is – well this tells a different story; hidden cuts that hurt:

Stealth cuts of £2 billion cripple NHS - report — RT UK 

 Stealth cuts of £2 billion cripple NHS - report

 April 26, 2015 

 

 

Reuters / Toby Melville

 

  

Hospitals in England are being hit by “stealth cuts” of more than £2 billion

($3.03 billion) since 2010 according to new research, blaming the cuts for

"rapidly deteriorating" hospitals’ finances.

 

Tariffs – hospital price payments per procedure, fixed by the National Health

Service (NHS) – have been massively reduced in the past five years according to

research carried out by the False Economy think tank, which was commissioned by the TUC and Unison. And those tariffs are where two-thirds of English hospitals' income comes from, the study adds.

 

The research found that one of four elective procedures, such as treatment for blood poisoning or diabetes, have had their tariffs slashed by more than 40 percent since 2010.

 

By examining 138 NHS procedures, the researchers found that between 2010 and 2015 hospitals suffered an income loss amounting to £70 million ($106).

 

Some treatments suffered cuts of 85 percent, including leukemia, asthma and sickle cell anemia, while cash for conditions like tuberculosis and glaucoma had been reduced by more than 70 percent and conditions like septicemia and kidney stones have had the amount given to them reduced by more than half.

 

When applied across all 4,500 tariffs, which make up most of the funding given to hospitals, the cuts amounted to more than £2 billion ($3.03 billion) over five years, making a mockery of the government’s claim that funding for the NHS has been ring fenced.

 

“These stealth cuts may have been largely hidden from the public eye, but the effects are grave. The NHS is in a rapidly deteriorating financial position, with hospital finances in steep decline,” said Frances O’Grady, TUC general secretary, in a statement.

 

Dr. Mark Porter, the head of the British Medical Association, said that the reductions in tariffs are part of a wider problem of cost cutting in the NHS.

 

“Cutting hospital tariffs causes real hardship for NHS services which are already struggling under rising patient demand, especially from an ageing population. This will push NHS organizations further into deficit, making a mockery of claims to have protected the NHS from cuts,” he told the Independent.

 

However, the NHS insisted that funding is going up rather than down.

 

“Rather than being cut, hospital funding in England has gone up, rising over the past three years from £49 billion to over £56 billion, a real terms increase of 9 percent,” said an NHS spokesman in a statement.

 

A spokesman for the Conservatives also insisted that hospitals had seen an increase in their budgets.

“Getting efficiency from the tariff is an important part of driving better value for taxpayers from the NHS, which is why it has been the policy of successive governments. Hospitals have seen real-terms increases in their budgets this Parliament, and unlike Ed Miliband, we’re committing to the £8 billion the NHS says it needs to transform community care,” he said.

 

However, NHS providers, like organizations providing mental health and ambulance services, are opposed to the cuts in tariffs.

“It is now widely accepted that 2015/16 will be the most difficult financial year for the NHS in its recent history,” they warned in January, according to the Independent.

I suppose the greatest scandal in all this is the 85% reduction in rates for the treatment of Sickle cell anaemia, which is a disease specific to African and afro-Caribbean people and has never been properly addressed in this country.

You only have to work for the NHS or be a patient to know that the Tory figures don’t add up.

Neil Harris

(a don’t stop till you drop production)

Home: helpmesortoutthenhs.blogspot.com

Contact me: neilwithpromisestokeep@gmail.co.uk

Bart's Health trust - told you so!

I'm reprinting an article from September 2013. As you can see, it wasn't the first time that I'd warned about the scandal at Bart's Health Trust.

It's quite simple; I looked at the extraordinary number of 'never happen' events that were taking place at the trust.

It's not the only measure of what's going wrong at a hospital. It's just one of many.

Two years down the line and Bart's Health trust has been taken into special measures.

It's about time....time for managers and senior health professionals at the trust to resign. We'll see if that happens.

Meanwhile you read it here first, two years ago; 

 

 

Tuesday, 10 September 2013

More questions about Barts health NHS Trust.

O.K.

I’m getting seriously worried about Bart’s Health NHS Trust which is in fact a large grouping of East End Hospitals, swallowed up by inappropriate mergers over the years. This is what I wrote in May of this year after I analysed the ‘Bottom 21’ Trusts for ‘Never Events’, things that should never happen because they are completely preventable:

My own ‘Lantern Rouge’ (that’s the Tour de France prize for finishing last) is because I’ve picked out the two separate entries for ‘Bart’s’;

Bart’s& The London NHS Trust 8

              Retained foreign object post-operation 4

              Wrong site surgery 2

              Misplaced naso-or oro-gastric tubes 2

Bart’s Health NHS Trust 11

               Retained foreign object post-operation 4

               Wrong site surgery 3

               Misplaced naso-or oro-gastric tubes 2

               Wrong implant/prosthesis 1

               Air Embolism 1

and I did so because Barts Health was formed on 1 April 2012 by the merger of Barts and the London NHS Trust, Newham University Hospital NHS Trust and Whipps Cross University Hospital NHS Trust.

For starters that means that St Bartholomew’s may have had its figures split in two and actually had 19 ‘never happen’ incidents over that four year period which is seriously worrying. Even more worrying is that the newly combined Trust – the four hospitals together- seems to have had 11 incidents in just under a year (2012/13).

If you want to get really frightened, add up the number of incidents over the four hospitals for those four years – it’s a total of 27. Or is there duplication in these figures? Have they tried to separate the new from the old, producing double counting? I hope so – mind you where the NHS is concerned the problem is usually undercounting problems.

Either way, it’s not what I would call a centre of excellence.

So if Barts it isn’t being investigated right now, it’s time it was.”

I didn’t believe my eyes, so I left it as a question.

Then I got my answer in The London Standard two months later:

“An inquiry was ordered today at Britain’s biggest health trust in response to the deaths of 28 patients due to medical blunders last year.

 Barts health trust — which runs six London hospitals — was declared at “high risk” of failing patients, with major concerns about delays in cancer care and hundreds of emergency cases readmitted for further treatment.

The inquiry was ordered by England’s new Chief Inspector of Hospitals, Professor Sir Mike Richards, in his first day in the job. It comes after Barts last night said it was calling in financial trouble-shooters to address a £93 million debt.

Sir Mike was alerted by whistle-blowers, patient complaints and key measures indicating the performance at Barts was markedly worse than the national average. This included 10 “never events” — things that should never happen in surgery — involving seven cases where swabs were left inside patients, two cases where the wrong teeth were removed and one where the wrong eye implant was inserted.

 

Barts also admitted 348 serious incidents in 2012/13, including 129 at The Royal London Hospital in Whitechapel, and 105 at Whipps Cross in Leytonstone. Of these, 28 resulted in death.”

 

Now I am really concerned. Yesterday I posted the Freedom of Information responses from 101 NHS Trusts – replies to requests for Information made by the BBC News team about the number of unfilled vacancies at Accident and Emergency departments.

I went back to the figures to find out what has been going on down at Bart’s Health NHS Trust and the answer is……nothing…..nadda….nowt…zilch.

They didn’t provide the information.

So, of course, the only explanation is that the management, after failing to sort out its fairly serious problems has responded by hiding the result of the problems under the carpet. Given the extent of their troubles it would be no surprise to discover that staff are leaving and aren’t replaced and we have a right to know.

Its bad when there are problems, it’s much worse when you cover them up.

What else are they hiding?

Neil Harris

(a don't stop till you drop production)

Home:  helpmesortoutthenhs.blogspot.com

Contact me: neilwithpromisestokeep@gmail.com

 

 

Morecombe Bay NHS Trust, 12 avoidable deaths in maternity.

This is another very long awaited report.

Morecombe Bay Hospital suffered a series of deaths of babies and mothers at its maternity unit – a number far higher than this report accepts.

There followed a similar pattern; denial by the hospital and the professionals involved, the deaths rising to a level where local patients start campaigning, staff move on, there is an investigation and…….everything is fine.

It isn’t.

Furness General Hospital and it’s trust has had problems in a number of areas – for example I’ve catalogued it’s poor record in ‘Never happen Events’.

In this case there seems t have been a climate of incompetence, bullying and a very real cover up.

Preparing answers for everyone to follow at an inquest is the offence of ‘perverting the course of justice; prosecutions should follow.

This report is from ‘The Independent’ newspaper today;

Morecambe Bay hospital report finds 'lethal mix' of failures led to 11 baby deaths

 

The investigation has recommended a national review of NHS maternity services

 

Charlie Cooper

Health Correspondent 

Tuesday 03 March 2015

 

A “lethal mix” of incompetence, cover-up and failure to learn from mistakes led to the preventable deaths of 11 babies and one mother at a rural NHS hospital in Cumbria, a long-awaited report has said.

 

The inquiry into maternity services at Furness General Hospital between 2004 and 2013 found “failures at almost every level”, from the maternity ward to national NHS regulators and the Department of Health, who missed opportunities to investigate a series of serious incidents.

 

The investigation, led by Dr Bill Kirkup, has recommended a national review of NHS maternity services and care for children in rural areas.

 

In total the inquiry uncovered 20 instances of significant or major care failures at Furness General, part of the University Hospitals of Morecambe Bay (UHMB) NHS Foundation Trust. Failures occurred in the run-up to the deaths of 16 babies at or shortly after birth, as well as the deaths of three mothers.

 

Better care could have saved the lives of 11 of the babies and one of the mothers, the report said.

 

Staff on the unit in Barrow-in-Furness lacked essential “skills and knowledge” and working relationships between doctors and midwives were “extremely poor” with a “them and us” mentality that prevented safe working.

 

Midwives failed to keep up with the latest national standards of care and were heavily influenced by a small group of “dominant” midwives who pursued normal childbirth “at any cost”, the report said, leading to avoidable mortality rates that were four times higher than neighbouring hospitals.

 

A “strong group mentality” among midwives known as “the musketeers” hindered investigations into the incidents. The inquiry found “clear evidence of distortion of the truth” in responses to investigation. In preparation for an inquest into one of the incidents, "model answers" to difficult questions were circulated among midwives, the report said.

 

However, the UHMB Trust, as well as regional and national authorities, were slow to investigate and between them missed seven opportunities to intervene in the three years from 2008, when five serious incidents occurred within a short space of time.

 

Proper investigations as far back as 2004 would have raised the alarm, the report said.

 

The report added that without the efforts of bereaved families, the scale of the failings would never have been brought to light.

 

The report makes 44 recommendations for the Trust and for the wider NHS.

 

Investigation chairman Dr Bill Kirkup said: “All healthcare – everywhere – includes the possibility of error. The great majority of NHS staff know this and work hard to avoid it. They should not be blamed or criticised when errors occur despite their efforts.

 

"But in return, all of us who work for the NHS owe the public a duty to be open and honest when things go wrong, most of all to those affected, and to learn from what has happened. This is the contract that was broken in Morecambe Bay.”

 

He added: “There was a disturbing catalogue of missed opportunities, initially and most significantly by the Trust but subsequently involving the North West Strategic Health Authority, the Care Quality Commission, Monitor, the Parliamentary and Health Service Ombudsman and the Department of Health.”

 

The report also recommended that the General Medical Council and the Nursing and Midwifery Council should consider investigating the conduct of those involved in patient care during the incidents investigated.

 

The Trust has undergone changes in management since 2012, and the report said there were now “welcome signs of significant recent improvement” including in maternity services.

Neil Harris

(a don’t stop till you drop production)

Home: helpmesortoutthenhs.blogspot.com

Contact me: neilwithpromisestokeep@gmail.com

Hips; saving money costs lives yet again.

For the last 20 years, it has been a given in the NHS that patients need to be sent home as soon as possible after an operation or treatment; ‘it’s in the patient’s best interests’.

Ask any patient and they will tell you they were sent home too early – I certainly was. In my case one extra day would have made all the difference.

In fact it’s all aimed at reducing the number of occupied beds and thereby reducing costs.

The assumption that the ‘community’ or ‘family’ will help out just leaves a lot of vulnerable people at risk.

The problem is that there aren’t the medical facilities and knowledge available at home. Often there isn’t a family or a community to help out.

The importance of this study is that it uses survival rates after hip injuries which are one of a number of international standard for hospital outcomes. The results for one country are relevant to another; in this case our results would be worse than Sweden as our community facilities are worse than theirs.

The fact is that sending patients home too early may save money but it costs lives.

The answer may well be to have wards with reduced medical cover for those who are recuperating rather than being actively treated;

Short hospital stays after hip fracture 'may increase risk of death'

Medical News Today

 

Wednesday 25 February 2015

 

A new study published in The BMJ finds that adults aged 50 and older who are subject to short-term hospital stays after admission for hip fractures may be at higher risk of death than those who have longer hospital stays.

 

Researchers found that hospital stays lasting less than 10 days after hip fracture was associated with increased risk of death.

 

Hip fractures are an increasingly common problem among older adults, with more than 95% of cases being caused by falls.

 

In 2010, there were around 258,000 hospital admissions in the US for hip fractures among adults aged 65 and older. And according to the Centers for Disease Control and Prevention (CDC), the number of hip fracture-related hospital admissions is expected to rise in coming years along with the aging population.

 

These admissions put an enormous strain on health care services and costs.

One-way health care systems have attempted to reduce this burden is by reducing the length of hospital stays for patients, referring them to home- or community-based care instead.

 

However, the researchers of this latest study - from Umeå University in Sweden - note that there are fewer sufficiently educated staff outside of hospital settings, and shorter hospital stays may mean the patient has less time for satisfactory rehabilitation.

 

These points raise the question: does early hospital discharge increase patients' risk of complications and death?

 

Patients at twice the risk of death with short-term hospital stays;

To find out, the team assessed 116,111 Swedish patients aged 50 and older who had been admitted to the hospital for hip fractures between 2006 and 2012.

 

The researchers analyzed how long the patients stayed in hospital and calculated their risk of dying within 30 days after being discharged.

 

Between 2006 and 2012, the team found that the average length of stay in the hospital for hip fracture patients fell by around 20%, from 14.2 days to 11.6 days.

 

Compared with patients who stayed in the hospital for at least 15 days, those who stayed in the hospital for 5 days or less were twice as likely to die within 30 days of being discharged, according to the researchers.

 

In addition, the researchers found that for patients whose hospital stay lasted less than 10 days, each 1-day reduction in length of stay was associated with an 8% increased risk of death in the 30 days following discharge.

 

Male patients and those with pre-existing heart, lung or kidney disease were found to be at highest risk of death in the 30 days after discharge following short-term hospital stays. Commenting on their findings, the researchers say:

"Our results suggest that the continuous efforts to decrease length of stay after major surgery in many countries is associated with higher mortality after hospital discharge.

 

In addition to evaluation of other diagnoses than hip fractures, further research should seek to gain a better understanding of the underlying cause of the increased risk of death after discharge in surgical patients, and evaluate whether early discharge to rehabilitation centers or nursing homes is associated with a worse outcome."

 

The researchers admit their findings are subject to some limitations. For example, following a hip fracture, risk of death is highest early on. This means that if a patient's length of hospital stay is reduced, they will automatically be at increased risk of death. "In the present study, this could bias the association between length of stay and death during follow-up as length of stay decreased," the authors note.

 

In addition, the researchers say they were unable to assess whether subjects received home- or community-based care following discharge, noting that it would be interesting to see whether one or the other may lead to a more positive outcome.

 

In an editorial linked to the study, Peter Cram and Raphael Philip Rush - both of the University of Toronto in Canada - say these study results may "serve as further warning to those who seek to discharge patients as quickly as possible."

 

"As clinicians we should be aware that, although hospitals are scarce resources, rapid discharge of patients should be considered carefully," they add. "For some patients, early discharge is likely beneficial and for others perhaps not. As policy makers, we should be aware that, while we have the tools to reduce length of stay, the potential for unintended consequences should not be forgotten."

 

In February 2014, Medical News Today reported on a study published in JAMA suggesting that home-based exercise programs may improve recovery for patients following hip fracture.

Written by Honor Whiteman

References;

Length of hospital stay after hip fracture and short term risk of death after discharge: a total cohort study in Sweden, Peter Nordström, et al.,  BMJ, doi: 10.1136/bmj.h696, published online 24 February 2015.

 

  Length of hospital stay after hip fracture: how low can we go before patients are at risk?, Peter Cram, Raphael Philip Rush, BMJ, doi: 10.1136/bmj.h823,   editorial.

 

  Additional source: CDC, Hip fractures among older adults, accessed 23 February 2015.

 

  Please use one of the following formats to cite this article in your essay, paper or report:

  Whiteman, Honor. "Short hospital stays after hip fracture 'may increase risk of death'." Medical News Today. MediLexicon, Intl., 25 Feb. 2015.

Medical News Today is concerned about it's copyrite; in this case this article is really an abstract of a British medical Journal article and therefore (with the correct attributions) I am reproducing it.

Neil Harris

(a don’t stop till you drop production)

Home: helpmesortoutthenhs.blogspot.com

Contact me: neilwithpromisestokeep@gmail.com