Journal Article

OP06 Facilitating hospital discharge through a housing support service: a mixed-methods evaluation in two UK hospital trusts

Gilbertson, Janet, Holding, Eleanor, Thorpe, David, Holliday, Judith, Ismaelette Del Rosario, Peace, Arron, Kahn, Wajid, Foster, Alexis, Lumley, Elizabeth, Roxby, Sarah

2023

Overview

BackgroundDelayed discharge from hospital is a global problem with negative consequences for patients and the healthcare system. Common causes of delayed discharge for patients medically ready for discharge are issues such as a lack of appropriate social care or housing for their needs. However, whilst there is now a plethora of non-medical interventions which have been developed to facilitate timely discharge there remains a lack of evidence on their impact. To bridge this gap in evidence we aimed to explore the impact of a housing support coordinator (HSC) on hospital discharge processes, service user outcomes and hospital costs. The aim of the HSC service was to work with patients on their housing related issues whilst in hospital to improve hospital discharge outcomes and reduce chances of readmission.MethodsWe conducted a mixed methods process evaluation in two UK hospital trusts employing semi structured interviews with service users, hospital and housing staff (=16), secondary analysis of routine patient data (N=488) and an economic evaluation to assess costs. Framework analysis was undertaken on the qualitative data using an initial framework developed from discussions with housing and NHS partners. Descriptive analysis was undertaken for routinely collected data. We used the ‘following the thread’ technique to integrate the different methods. A sense checking workshop was conducted to ensure the findings reflected stakeholder experiences.Results488 people were supported by the service. Almost two thirds were male (n=321). Service-users faced different housing barriers. Over 25% experienced homelessness (n=136) and a further 52 faced challenges with their accommodation no longer meeting their physical needs. Service users were appreciative of the service and received support for a variety of issues such as assistance with medical priority, assisted bidding on properties and referral to other support services. Hospital staff at all levels felt the service facilitated discharge and significantly reduced stress on clinical staff. Having experienced housing officers embedded within the patient’s care team with access to medical systems was key. The service was constrained by the unavailability of appropriate housing stock and wider support systems for service-users post discharge.ConclusionThe evaluation has demonstrated the benefits of housing services to support hospital discharge. The findings were used to develop several recommendations for the service which will be of use to other organisations wishing to develop similar integrated services. It is recommended other hospitals experiencing housing related barriers to discharge may want to adopt a similar model.

• Publisher: BMJ Publishing Group LTD
• Subject: Cost assessments / Homelessness / Hospital costs / Housing / Mixed methods research / Patients / Secondary analysis