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Delayed discharge and hospital congestion

BMJ 2003; 326 doi: (Published 04 January 2003) Cite this as: BMJ 2003;326:48

One nettle to be grasped is discharging patients against their or their families' wishes…

  1. David R J Jarrett, consultant geriatrician (,
  2. Anna Hinton, specialist registrar
  1. Department of Medicine for Elderly People, Queen Alexandra Hospital, Portsmouth P06 3LY
  2. Queen's Medical Centre, Nottingham NG7 1AE

    EDITOR—Black and Pearson identified the complex factors driving up length of stay and causing palpable tensions in every hospital in the United Kingdom.1 The NHS is unique among health services in having no effective lever to discharge patients who no longer require hospital care. Black and Pearson say that patients can elect to remain in hospital until a final placement is found. In reality it is not so much patients seeking placements at rest homes and nursing homes but their families, who have the power to adopt an approach of masterful inactivity to discharge.

    In North America and most of Europe powerful financial incentives mitigate unnecessary delays to discharge from hospital. We …

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