Discharge delays in medically fit patients with altered social support needs

Prolonged hospital stays for medically fit patients pending discharge destinations are a persistent problem for the national health service, depleting funds and bed availability. Crucially, patients risk hospital-acquired infection, institutionalisation and deconditioning. Discharge destinations for patients with altered need for government-funded social support are decided following submission of a universal referral form (URF), completed by the multidisciplinary team (MDT). Policy states URFs should be submitted 48 hours after a patient is deemed medically fit for discharge (MFFD). We hypothesised that URF submission contributed to discharge delays.

Our quality improvement project reviewed the time taken to complete URFs on an older adult ward at Musgrove Park Hospital during March 2025.  Inclusion criteria required a change to the patient’s social support upon discharge, without private funding or palliative plans.

We found 40.6% of URFs were submitted within 72 hours of MFFD status. Furthermore, 34.4% took over a week, and 9.4% took over three weeks to submit. Findings were presented at a governance meeting, which recommended reducing the number of staff needed to complete URFs, covering discharge team absences and drafting URFs 48 hours before MFFD status (guided by morning MDT meetings). Following the implementation of these changes, data collection was repeated in July 2025. 58.3% of URFs were submitted within 72 hours of MFFD status, 16.7% took over a week, and 0% had delays over three weeks.

These changes were supported by previous research, which suggested unmanageable workloads, unclear ownership and ambiguous treatment plans as potential delays in URF submission. Our two-cycle project identified a delay in URF submissions, and using a collaborative approach, we reduced the length of hospital stays. However, struggles to meet target timescales remain, and further investigation is needed. This includes a repeat cycle in three months on a larger cohort, to confirm the implemented changes are sustainable.