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Coronavirus staff guidance University Hospitals Birmingham NHS Foundation Trust

Discharging patients

Discharge Information

A leaflet has been produced to support patients being discharged with COVID-19 disease which is available to view from the "Downloads" section.

Initial copies will be distributed to wards centrally. Thereafter, print copies will be available in bulk from the Graphics Department. The reference to order more copies is: PI2189.

Discharging patients to residential/nursing care homes

The Trust is now required to test patients prior to discharge to residential/nursing care homes as required within the COVID-19 adult social care action plan issued on Thursday 16 April 2020.

The following testing policy has now been agreed by MSAG for immediate implementation:

  • If a patient has tested negative for COVID-19 during their stay in hospital, then they must be re-tested prior to discharge to a residential/care home 
  • If a patient has not been tested for COVID-19, then they must be tested prior to discharge to a residential/care home
  • If a patient has already tested positive for COVID-19, then no further testing will be required prior to discharge. This is because the test will remain positive for 21 days (if not longer) and as such well beyond the period within which one can pass the infection on to the others. If a patient misses their planned discharge date, there will be circumstances where the test will need to be repeated.

If a patient misses their planned discharge date, there will be circumstances where the test will need to be repeated.

Patient tests prior to discharge will be arranged by the ward team following a request by the hospital discharge hub who are responsible for coordinating new care home placements. The policy will cover all patients being discharged to a care home regardless of whether this is a long term placement or for a period of rehabilitation/enhanced assessment.  

If a person usually lives in a care home and is likely to be able to be returned there in less than 72 hours (without the need for the involvement of the discharge hub) it is recommended this patient is tested on admission to the ward to optimise the chance of a timely discharge.   

In terms of calculation of the duration of COVID-19 plus disease, this will be from the recorded date of the positive test.

The result of any COVID-19 test undertaken prior to discharge will need to be included in the ward discharge letter. The test result will also be communicated to the care home by the discharge hub team where they coordinate the discharge.

Patients who are not admitted into base wards but instead attend ED or an assessment area will not be tested prior to returning to a care home.

It should be noted that this testing policy does not apply to patients for discharge home with a domiciliary care provider.

Information to be included in the discharge letter Regarding a COVID-19 test

COVID-19 status of an individual

  • The date and result of any COVID-19 test
  • The date of onset of symptoms
  • The care plan for discharge from isolation

When the patient’s discharge is being managed by the Complex Discharge Hub, an identified Complex Discharge Nurse Specialist will

  • Prompt the ward to carry out COVID-19 swabbing
  • Interface with the care provider/home regarding the result

Whilst we can request that the care home /care provider take a patient prior to a test result being available they are within their rights to request the result is back and available to the care provider/home prior to patient being discharged. If patient tests positive and the care provider/home can no longer meet the patient’s requirement due to the result, the discharge hub will coordinate referral for an alternative placement or source out to brokerage for an alternative care provider.

If the Complex Discharge Hub is not involved in the patient’s discharge, the ward must:

  • swab the patients
  • interface with the Care provider/home regarding the result prior to discharge

What to do if the care home/provider cannot support the patients discharge due to lack of PPE

UHB have agreed to continue to support care homes/providers on discharge if they identify lack of PPE to care for the patient.

If this is the case, five days worth of PPE must be provided on discharge, from ward stock levels and include a box of type IIR surgical masks, roll of aprons and box of gloves. Ward stock levels are replenished daily by logistics teams.

When not to test

Care home residents who attend an A&E Department and are not presenting with COVID-19 symptoms and who, following assessment, are deemed fit to return to their home will not be tested prior to their return. This is in line with the national guidance.

If a care home refuses to take the patient back despite the guidance above please contact Andrew Mckirgan/Sarah Carmalt with the following details:

  • patient name
  • date of Birth
  • care home address

Email: Andrew.Mckirgan@uhb.nhs.uk
Email: Sarah.Carmalt@uhb.nhs.uk

If a care home resident presents in ED with COVID-19 symptoms, tests positive and is still deemed fit to be discharged, a conversation should take place with the care home explaining isolation requirements.

If the care home does not feel they can meet isolation requirements, the patients will need to be referred OPAL/Complex Discharge to source an alternative placement, this will usually require admission to UHB whilst placement is being sourced.

Isolation

When a patient is to be discharged to a nursing/residential home or for a package of care and has been identified as requiring isolation due to either a COVID-19 positive result or high risk of exposure to COVID-19.

A conversation should take place with the nursing/residential home regarding the requirements for a patient to be isolated on discharge.

If the nursing/residential home cannot support this the patient must complete their period of isolation within the patients ward.

Where a care provider will not provide a package of care for patients requiring isolation at home, the Complex Discharge Team leads must escalate to commissioning to look at sourcing an alternative provider.

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