In this personal blog, College President Professor Jackie Taylor writes on the current public discussion on the discharge of patients from hospitals to care homes.
“The public is right to expect that the best interests of patients remain at the forefront of all the decisions made by doctors, especially as we progress through the current COVID-19 pandemic. The issue of transfer of patients from hospital to care homes has been a topic of public discussion over the last week. In these challenging times, it is essential that guidance is grounded in science and best practice, and that clinicians are empowered to use their clinical judgement with respect to the care of individual patients. Wherever our most frail and vulnerable patients are, be it in hospital, a care home or their own home, we want to ensure that they receive the best patient centred care possible.
Public Health Scotland published a document in August, “Guidance for stepdown of infection control precautions and discharging COVID-19 patients from hospital to residential settings” which contains the full guidance for health and social care professionals.
In the majority of situations a patient who has had Covid19 would have two negative tests before discharge from hospital. There are situations however where this may simply not be possible.
For example, it is well established that some patients continue shed viral fragments and to give positive test results for COVID-19 virus for months and long after they cease to be infectious to others. Patients may refuse consent, or lack capacity to give consent to a test. Anyone who has had a swab taken for a COVID-19 test will know how that it is unpleasant. For some vulnerable patients, carrying out this invasive procedure might cause enormous distress and actually be very difficult to conduct. Should this then mean that a patient is denied return to what is essentially their home?
In these circumstances it is important that clinical judgement is used and that the best interests of the patient are put at the centre of what we do. Shared decision making and discussion with the patient, their family and with the care home is essential and all appropriate mitigating actions and support should be in place before, during and after any transfer.
As doctors we spend much of our time weighing up risks and benefits, and trying to make the best decisions that we can. Policies and guidance are of fundamental importance in clinical practice, but none can cover all eventualities. Discharge planning is a complex process. Clinical decisions are never taken lightly, but thoughtfully, carefully and compassionately and always with the patient at the heart of the process.”