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Views And Reviews Acute Perspective

David Oliver: The risks of discharging patients early against doctors’ judgment

BMJ 2020; 368 doi: (Published 22 January 2020) Cite this as: BMJ 2020;368:m210

Linked Opinion

Discharging patients early, where does legal responsibility lie?

  1. David Oliver, consultant in geriatrics and general medicine
  1. Berkshire
  1. davidoliver372{at}

On 13 January the BBC reported the contents of an internal email to doctors from the medical director and chief nursing officer at the Royal Cornwall Hospital.1 In response to “significant pressure,” and to free up bed capacity, the email urged doctors to discharge patients “earlier than some clinicians would like.”

Last month the Guardian had carried a similar story from Norfolk and Norwich University Hospital, reporting internal memos urging senior doctors to find the “least unsafe option” in identifying patients to discharge.2

No doubt, senior operational and clinician managers at those trusts face an almost impossible balancing act. I’m sure that you’d find similar emails in dozens of acute hospitals around the NHS, given that they start each day in negative bed equity, with patients queuing in the emergency department, sometimes on trolleys in corridors.

What struck me about both cases was that the …

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