Dear Editor,
I READ in the electronic media that the GPHC CEO, Brigadier (Ret’d) George Lewis was complaining “that families continue to dump elderly relatives at GPHC.”
Let me be honest. I do not know if that was his choice of words, but that was the headline. I do have concerns with that, since patients are not cargo and the word “dump” when referring to a human being is insensitive, disrespectful and devaluing. Being unwell is stressful enough; being looked at as cargo surely wouldn’t help.

Anyway, that’s not my reason for writing today. My reason for writing is to state that this issue is not new and it is worldwide. The fact is, that this has been happening for decades. It generally peaks during the Christmas season for obvious reasons. This issue is very old and it would beg the question, why a solution or attempt at a solution has never been proposed? It was clearly there during the PPP’s 23- year reign, when Mr. Michael Khan was the CEO and it was definitely there during PNC’s 28-year reign.

The fact is that the families wouldn’t change; they clearly haven’t changed over the decades. As a result, it is incumbent that the hospital administration adapts and be innovative. Patient and relative-blaming is not the way forward. I am no hospital administrator, but common sense would make me suggest the following recommendations.

1. What about having a step-down clinical care institution, to which those patients can be transferred once their acute problems have been addressed? That’s less costly and frees up desperately needed and acutely limited hospital beds. Monies are there for costly drug bonds under the PPP, PNC and now APNU+AFC.

2. What about engaging with the families to see where the problems lie? Sometimes it may be just a simple but understandable fear and concern, that they are not equipped to deal with their elderly relatives increased social and clinical needs soon after an acute illness. It may just be that their actions are cries for help for a break from a demanding and mentally stressful duty.

3. What about engaging with the patient? They may have an understanding of their clinical needs and may articulate same?

4. What about providing respite for the families? Taking care of an elderly relative can be quite costly and mentally demanding. The government can probably fund respite care for families, caring for elderly relatives, for a limited period for example at the Palms or Uncle Eddy’s Home; even encouraging investors to invest in nursing homes and care homes. The world population is getting older. We need to start thinking of solutions to address this.

5. What about educating the families of the many risks of leaving their elderly relatives in hospital when they need not be there? The education can take the form of booklets handed out to families on admission of their elderly relatives. This can be reinforced by healthcare professionals. Such risks include, but are not limited to hospital-acquired, deadly infections; increased risk of falls with serious life-threatening injuries, increased confusion, and bed sores among others.

6. What about having a radio and TV campaign to address this issue? The hospital can have televisions and conspicuous posters around the wards; these can provide educational information– including this issue– that the relatives can view while visiting their loved ones.

7. What about employing “discharge coordinators?” Their jobs would be basically to go around the wards and gather information on elderly patients who were discharged. Electronic patient records may facilitate this process. They gather this electronic information in their offices and make a list of patients that need to be reviewed. This will make for a more efficient service. They can then facilitate those discharged by addressing the issues outlined above. It can be argued that these discharge coordinators and consultants should be pre-emptive rather than reactive. The consultants should inform them a few days in advance of potential discharge dates for given patients. This is not definitive, but merely an estimated date of discharge. The discharge coordinators can then start the ball rolling by identifying and addressing problems; so hopefully by the date of discharge, there will be no hurdles.

8. What about having discharge teams made up of physiotherapists, occupational therapists, social workers, discharge coordinators, etc? These teams would have the skillsets to address the common problem that may serve as a potential hurdle for timely discharge.

9. What about gathering data on individual consultants’ discharge numbers and also common reasons why patients are not being discharged despite being medical fit for discharge? These data may provide useful information that the hospital can use to develop solution strategies. This can be combined with data on hospital re-admission rates for given patients, over a specified period; for example, 90 days since discharged. This would identify failed discharges from which everyone can learn.

10. What about investing and improving primary care? In my experience, elderly patients’ illnesses rarely come on unexpectedly,they build up gradually; and If addressed in a timely manner in primary care, can negate hospital acute admissions. Finally, it is a fact that acute hospital beds are very expensive and limited. Much more expensive than a day stay at the Marriott’s executive suite. What I’m suggesting are cheaper alternatives, although I am not a qualified hospital administrator.

As a result, I would humbly suggest that Brigadier (Ret’d) George Lewis spend less time complaining and relatives blaming and more time developing innovative strategies to address this perennial problem. The evidence is that patients and relatives wouldn’t change if they are not provided a reason to. As a result, it is imperative that the GPHC administration be strategic and think out of the box about solutions and hopefully modify relatives’ behaviours.

Regards
Dr. Mark Devonish MBBS MSc MRCP(UK) FRCP(Edin)
Consultant, Acute Medicine
Nottingham University Hospital
UK