An auditor-general’s report into the management of long-stay patients in WA hospitals has found the state has a huge problem with patients “stranded” in hospital despite being fit for discharge.
- A lack of real-time notification on patient status is a major hurdle
- Thousands more people could be treated with a better system
- The Health Minister says the report would form the basis for improvements
Auditor-general Caroline Spencer found some patients stay in hospital months, and even years longer than medically necessary when often they would be better served in aged, disability or other care.
It is not a new problem and there is a myriad of complex cross-agency, cross-sectoral and cross-governmental issues behind it.
But Ms Spencer found WA Health faces one major hurdle getting in the way of addressing any of the underlying problems.
The report sets out that WA Health lacks any real-time monitoring system to show when a patient should be discharged or why discharge is delayed.
As a result, the report states the Health Department has a limited understanding of the scale, cost, and impact of long-stay patients on public hospitals.
“A starting point for the Department of Health would be to have a flag in their system of when a patient has been assessed as medically fit to leave the hospital system,” Ms Spencer said.
“And then they can manage their patient cohort on a systemic level, they understand why people are there, and who to actively help transition out of hospital.
“If the Department of Health, as system manager, doesn’t have real-time information on how many patients no longer need to be in hospital, they are not able to identify best patient flows, where those people are best to receive care, also where best investment in additional bed capacity is made, or if it even needs to be made.”
‘Snapshot’ reports of limited use
While WA Health does not have real-time data on long-stay hospital patients, it does conduct periodic “snapshots” on some cohorts of long-stay patients.
Ms Spencer said because the information is static it has limited usefulness, but it does suggest how significant the problem is.
The report looked at two “snapshot” studies across 2021 and 2022 which indicated at various times over that period 486 people were stranded in Western Australian hospitals while they waited for NDIS or aged care services.
Using basic analysis, the report found if that cohort of patients were in more appropriate accommodation it could have freed up capacity to allow over 14,000 more people to access a hospital bed and saved the state $71.8 million.
In addition to blocking access to beds and the significant financial burden, the report found patients staying in hospital despite being medically fit to discharge suffer personally in several ways:
- Long-stay patients often do not have enough stimulation and activity, leading to reduced physical, mental and emotional wellbeing.
- When patients are stuck in beds, they are missing out on receiving services in the most suitable environment.
- Their capacity and opportunity for connecting within the community is reduced because they are removed from their home environment and regular social engagement with family and friends.
- Extended hospital stays may also increase the risk of hospital acquired infections and falls.
Ms Spencer said the concerns about WA Health’s data system for long-stay patients were not new.
“This isn’t a new issue, we have commented through successive audits on WA Health not using to best effect the data it has to make evidence-based decisions, both around patient flows and investment decisions,” she said.
“This really is about best patient care and making sure that patients are in the best patient care setting for their needs, so that they’re not in higher cost settings that don’t meet their needs.”
The report found a new WA Health committee and working group focused on long-stay patients had an impact for “some individual patients” but there was “little evidence to suggest a system-wide improvement on the size of the problem”.
The auditor-general noted the limited data available showed that between March 2021 and March of this year, 377 long-stay patients waiting for NDIS care were discharged.
But during the same period 379 new long-stay patients in that cohort were identified, suggesting “the underlying causes of the issue have not been effectively addressed”.
Health minister praises innovative solutions
In a statement the Health Minister, Amber-Jade Sanderson, said the challenges associated with long-stay patients were being experienced “Australia-wide” and that WA was leading the way with innovative solutions.
“Feedback from aged care sector is that WA is a national leader in this space and Federal NDIS Minister Bill Shorten, while in Perth last month, described our From Hospital to Home program for people with complex needs as a model that should be replicated around the nation,” she said.
“The McGowan Government is investing in a range of initiatives to help discharge long-stay patients into more appropriate accommodation and help them access suitable services, while continuing to advocate for our needs with the Federal Government.
“As part as our ongoing commitment to helping long-stay patients to exit hospital, WA Health will use the Auditor-General’s findings to improve processes to benefit of patients and the health system.”
Ms Sanderson also pointed to a $59.5-million state government investment in 120 new permanent aged care places, and $5.8 million to support a Long-Stay Patient Fund which had already enjoyed successes.
The Health Department’s formal response to the auditor-general stated the Department “agreed with the premise of the report”, it also noted the complexities in dealing with long-stay patients and detailed a range of work it is doing to try and address the problem.
But the auditor-general took less confidence in how the department plans to use $74.1 million in funding announced in May to try and reduce the number of long-stay patients.
The report warned the investment came with a “lack of a strategic plan” and would be hampered by an absence of specific targets, and ultimately by the lack of real-time data monitoring.