How patients who are deemed “surgically fit for discharge” but refuse to leave hospital are (a) recorded and (b) monitored, and whether thi…

Public Health Scotland publishes monthly Official Statistics on the number of people remaining in hospital after being declared ready for discharge, along with the reason for their delay. This information is recorded within each NHS board using a common set of definitions and codes applied across all NHS boards in Scotland.Inpatients are determined clinically ready for discharge by the consultant/GP responsible for the inpatient medical care and where a multi-disciplinary team has agreed that the individual’s care needs can be further assessed or properly met outside a hospital setting. Clinical readiness is not synonymous with surgical fitness for discharge.Refusal to leave hospital is not directly captured as a reason for delay in the common delayed discharge definitions.Delayed discharges due to patients exercising their statutory right to choice of care home accommodation are captured under two reason codes:71: Standard delays due to Patient exercising statutory right of choice, and71x: Complex (Code 9) delays due to Patient exercising statutory right of choice where an interim placement is not possible or reasonable.Patients recorded as delayed due to exercising their statutory right to choice (71 and 71x) should not be interpreted as refusing to leave hospital.Codes 71 and 71x are used when a patient has exercised their right to their choice of residential care home, which is a statutory right under The Social Work (Scotland) Act 1968 (Choice of Accommodation) Directions 1993. This right is subject to provisions, including that the chosen accommodation will be available within a reasonable period, the provider is willing to provide accommodation and the cost to the local authority is not more than it would usually expect to pay.The definitions further specify that code 71x: “…should only be used where long travel distances or limited transport infrastructures restrict the ability of families and friends to visit and where the placement may isolate the individual from a vital family and social network. This code should only be applied where remaining in a hospital setting is a more appropriate outcome and is the only viable alternative to an interim move. In all other choice cases (code 71) the underlying principle should be that remaining in hospital is not an option.”Any patient who refuses to leave hospital for any other reason other than exercising their statutory right to choice of accommodation may be recorded as delayed due to “Other patient/carer/family-related reason”, however not all patients recorded with this reason code can be said to be refusing to leave hospital.