In a climate of continued and yet unprecedented pressure on the NHS, Delayed Transfer of Care (DTOC) is not just another step in the patient journey. It’s a crucial step on the path to positive care outcomes. Since 2014/15 the number and rate of delayed transfers has been consistently rising.
Today, nine years on, delayed transfers of care (DTOCs) contribute to intensifying backlogs, rising costs, and more distress for patients. Can technology built to make healthcare more efficient influence both the extent of DTOC incidents and Trusts’ ability to deal with them?
Shiraz Austin, Managing Director at Scribetech (UK) Ltd – UK distributor for Augnito solutions – takes a deep dive into this topic.
Over the past few years, the number of available beds within the NHS has continued to decline.
In December 2022, the average daily number of beds was just 136,508. This reflects a ratio of 2.4 beds per 1000 people in the UK population – significantly lower than countries like Austria (7.1 beds/1000 people) and Germany (7.8 beds/1000 people).
There are a range of systemic, complex issues that contribute to the UK’s lack of NHS beds. Initiatives like the Urgent and Emergency Care Plan promise to improve this situation, but this is a slow, ongoing process. The results may only be seen years into the future, leaving Trusts, CCGs and healthcare providers to instead pay attention to a metric that’s more meaningful in the short-term: Delayed Transfers of Care, or DTOCs.
The scale of the DTOC problem
DTOC describes patients who are clinically ready to be transferred or discharged from acute or non-acute care, but continue to occupy a bed. This can result in needlessly long hospital stays for individual patients, as well as delays for other patients who are waiting for a bed.
While Delayed Transfers of Care should be minimised through effective discharge planning and joint working between NHS and social services to ensure safe, person-centred transfers, unfortunately, for the past two decades, this planning process hasn’t been as effective as it could be.
We might assume that the NHS carries the majority share of responsibility for delays, however, social care carries its fair share too. The overall pattern of DTOCs is not uniform between the two organisations responsible for the delay. Percentage increases for patients delayed, per day over a 10-year period, have fluctuated between these organisations’ systems, showing patients either awaiting a social care package in their own home, or awaiting further non-acute NHS care as being the main reasons for the DTOC.
In 2017 the NHS DTOC goal was just 3.5%. The gap between this goal and reality is significant.
If we look at data between August 2010 and 2017, NHS delays increased 25%, while social care delays were up 130%. By December 2018, the number had decreased by over one third to 4,155 patients delayed on average per day. Since then, data for February 2020 shows that the number increased again by 29%, to an average of 5,370 patients delayed per day.
What does this mean in terms of days and cost? In February 2020, there were 155,700 delayed days across the NHS. While NHS England paused reporting DTOC data as the COVID-19 pandemic intensified, a common-sense approach tells us the number of delayed days is likely to have worsened over the past three years.
For patients, DTOC severely impacts the quality of care being delivered and creates difficult, often distressing patient journeys. For the NHS, DTOC creates added staff pressures, workload burdens and a significant, unnecessary cost.
The financial impact of DTOCs
Findings published by the Government Statistics Service (GSS) for February 2020 show the average number of people delayed per day that month in England was 5370. While some sources like Age UK estimated the NHS excess bed day rate at £346 in 2019, the Department of Health report average costs in 2017 of around £400 depending on treatment. Multiply the delays per day by the day rate and we have an estimated cost of DTOC of £2,148,000 per day for February 2020 alone.
Yearly figures seem to have stopped being used past 2016, when a report by the National Audit Office (NAO) showed delays in discharging older patients from hospital when they no longer need care was costing the NHS £820 million per year.
The complexities of calculating excess bed day rates and recorded bed stays have been compounded by treatment tariffs and care cost models that do nothing to reduce the financial burden that DTOCs clearly carry. They reflect a direct cost in the £millions to the NHS – for maintaining patients in beds when they are ready to be discharged, or transferred, to home care or social care. And let’s not discount the financial ripple effect that DTOC has throughout the whole healthcare process that is even more difficult to track: poor bed availability, high occupancy and growing waiting lists. All resulting in patients entering the NHS system later, when their conditions may be more acute and, ultimately, more costly to treat.
Throughout the COVID-19 pandemic, the UK Government looked to help tackle this issue through funding designed to financially assist discharges to social care. However, with this funding planned to end after March 2023, the NHS will need to look at new ways to maximise limited budgets.
How speech recognition can support DTOC improvement
Technology like clinical speech recognition (SR) has the capacity to increase productivity and streamline the creation of medical documentation for healthcare professionals, easing the burden of growing admin workloads with faster, more flexible and mobile ways of working. We believe it can also influence key metrics such as DTOCs – as well as create savings for NHS budgets.
Reducing internal delays to discharge or transfer
In part, DTOC is affected by internal delays – the technical and logistical barriers to getting patients discharged swiftly and effectively. The administration involved in discharging or transferring patients must be efficient and accurate if they are to be discharged on time.
Developed in partnership with medical professionals, Augnito delivers cloud-based, AI-powered speech recognition on any device or operating system. Augnito empowers clinicians to capture live clinical patient data easily and wherever they need to, with extreme accuracy and none of the delays of manual transcription or digital dictation.
Patient notes, referrals, follow-up letters and care package instructions can be ‘spoken’ directly into an electronic patient record (EPR), simplifying the patient discharge or transfer process. This not only saves valuable time and money for the NHS and social care system, but also helps reduce the patient journey and, ultimately, improve care outcomes.
Reducing external factors on DTOCs
Efforts to tackle the DTOC problem will need a whole system-wide approach addressing the consistent lack of capacity across all parts of the system.
As outlined earlier in this document, DTOCs are not exclusively an NHS problem. The data referenced in ‘The scale of the DTOC problem’ highlights that in many cases, patients are unable to be discharged due to a lack of onward care, including from space in care homes to funding for home care services. Many of these challenges are the result of a health and social care system that continues to be under significant pressure, as well as a longstanding lack of investment in important provisions like community nursing.
It’s in the DTOC that the impact of clinical SR technology, like Augnito, has the potential to be most transformative. Switching to Augnito and using streamlined, automated clinical workflows can create an efficiency gain of around 5% per day. This time saving has a very real financial impact. It can provide a reduction in document turnaround time, patient referral record keeping, and clinical documentation inaccuracies/errors – as part of the discharge process and the patient onward care journey. This could save the NHS hundreds of thousands of pounds per month.
Currently, these productivity bottlenecks are a wasted administrative cost, not influencing or improving the patient experience. Transforming efficiency is significantly more cost-effective than trying to grow bed stocks. With a new, more seamless way of working, savings can be focused on what matters most: replacing the soon to cease March 2023 Government funding, and reinvesting in patient care by improving healthcare provisions outside the hospital environment, raising the standards of community care, and ensuring every patient can be discharged effectively and at the right time for a better outcome.
In our next blog, we’ll discuss in more depth how the financial implications of DTOC extend across the whole of the health and social care system and how savings could be repurposed for medical efficiency gains and an improved continuum of care.
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Augnito is already impacting the patient journey through our growing list of UK partners. Request an evaluation version or try the Augnito app to see how your system can benefit.