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April 15, 2011 10:05 pm
It can be hard to get into hospital – you may have a long wait in A&E before you secure a bed. But it can be even harder to get out. “Once upon a time,” said the sister on my ward, a nurse with 25 years’ experience, “we used to admit them, treat them, and send them home.” She picked absent-mindedly through a tin of Quality Street, a gift to the staff from Mr Banner’s niece. (After a 14-week stay Mr Banner had eventually been discharged to “Rose Cottage”: that is to say, he died.) “Remember when they used to LEAVE hospital? Give them some medicine, bandage them up – boom, home!” In contemporary British hospitals, the “boom, home!” dream can sometimes seem forlorn.
Youngish, fittish people who can look after themselves have the best chance of a rapid escape from hospital; they are likely to wait hours rather than weeks. What do they wait for?
All patients leaving hospital need to be seen by a member of the medical team (most often a doctor, sometimes a nurse) so they can be declared “medically fit”.
Medically fit implies that you are stable, and functioning, rather than necessarily better. Your physiology needs to have gone back to normal: so if you have had an operation, your bowel needs to demonstrate it has got over the shock by passing wind – at least – if not stool just yet; if you’ve had a catheter in, you need to show you can now pee unaided; if you weren’t eating, you need to have managed a meal. Your blood tests should have got better.
Then a doctor has to prescribe your medicines “TTA” (“to take away”) before the pharmacy can dispense them. It can take as long as a day for all of this to happen.
A day is still quick. Some patients have to wait weeks. Elderly people who were barely coping before they arrived in hospital are the most likely to get stuck. Mr Banner was 85 years old, a former steel worker with wasted arms and a wheezy chest.
It didn’t take long to treat the pneumonia that had brought him in. He had antibiotics by drip, and fluids, and was rapidly better. But he struggled to get out of his bed and into his chair. When he stood up, his balance was poor: he lurched dangerously forwards, or listed to one side.
The infection had rattled his poor memory to the point that he couldn’t always remember where he lived. The registrar wrote “MEDICALLY FIT” in his notes, then “PT/OT”, to ask the physiotherapist and the occupational therapist to come and assess Mr Banner.
The physiotherapist couldn’t get Mr Banner accustomed to a Zimmer frame: he would hold it with one hand and lean off in the opposite direction like a man hanging out of a bus.
The OT took Mr Banner for a “Kitchen” – an assessment of basic domestic skills – and discovered, as Mr Banner waited for an unplugged-in kettle to boil, that he had forgotten how to make a cup of tea. He failed his “Wash/Dress” – looking blankly at the flannel – he failed the “Stairs”.
He was medically fit, but not safe to go back to his house, where he lived alone with that great enemy of hospital discharge, an upstairs bedroom. He needed carers, at least; possibly a residential home.
The staff tried to work out exactly what level of help he needed, then they applied for funding to pay for this help. The wait for funding decisions is very long. Mr Banner was waiting when he died.
Sophie Harrison is a hospital doctor in South Yorkshire
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