Discharges from Northern Ireland hospitals to care homes decreased during the first Covid-19 surge compared to the same period in 2019, a newly published study has found.
The research looked at data for discharges, as well as considering if there was any correlation between discharges from hospitals and infection rates in care homes. The work could not identify any such correlation.
The study found that that the timing of outbreaks in care homes during the first surge does appear to correlate with overall hospital admissions rates for Covid-19 (which are an indicator of wider community transmission and infection levels).
Welcoming the publication, Health Minister Robin Swann said: “Care homes remain on the frontline in the battle against Covid-19. This research complements my Department’s Rapid Learning Initiative which also examined the first surge in the sector. It is vital that we keep adding to our learning as we continue to support care homes.”
The new study will be circulated to the care home sector to highlight the findings regarding correlation between care home outbreaks and hospital admissions and community transmission. This can help support the vital message that we can all help protect care homes by stopping the spread of the virus in the wider community.
The research was commissioned by the Department of Health and conducted by Dr Niall Herity, a consultant cardiologist at the Belfast Trust. He has previously provided in-depth statistical analysis for the Department on elective care across Northern Ireland.
Questions have been raised in the public domain as to whether there was a policy of accelerating discharges from hospitals to free up inpatient capacity during the first surge, and whether this caused Covid-19 outbreaks in care homes.
Key findings from Dr Niall Herity’s report are:
* The analysis demonstrates a decline in the numbers of people discharged from hospitals, including to care homes, from mid to late March onwards, reflecting an overall decline in Emergency Department attendances and hospital admissions.
* The study examined two specific weeks in 2020 where the number of people discharged to care homes after an unscheduled hospital admission was slightly higher than the typical weekly average. Among 465 patients discharged to care homes during these two weeks, five people (1.1%) tested positive within 2 weeks of discharge and 460 (98.9%) did not. This does not support a hypothesis that this group of people was a substantial cause of Covid-19 outbreaks in care homes
* The timing of outbreaks in care homes during the first pandemic surge correlates much better with hospital admissions rates for Covid than with the numbers of people discharged to care homes. This would align with conclusions from two national analyses of hospital discharges and outbreaks in care homes in Scotland and Wales. Hospital admission rates are an indicator of general transmission and infection rates in the community.
* Research findings do not support a view that Ministerial or Departmental communications drove consultants’ discharge decision-making during the first pandemic surge, including decisions to discharge people to care homes.
The decision to discharge a person after a hospital admission is an important clinical judgment taken by senior medical professionals, typically consultants. It is one that they take seriously, balancing the benefits versus the risks of a person remaining in hospital.
* Through the first surge of the Covid-19 pandemic, front-line clinical teams had more unoccupied beds available to them than usual, reflecting reduced attendances at emergency departments and reduced hospital admissions. Hence, there was less pressure to accelerate patients’ discharge from hospital than is normally the case, other than to minimise the well-known risks associated with being in hospital.
* Worldwide analysis shows that the experience of Northern Ireland’s care home residents has closely paralleled those of care home residents in many other parts of the world. Given the diversity of countries, regions and healthcare systems, any variances in local policies, guidelines or communications would seem to be less plausible explanations of care home outbreaks and consequent deaths, than the virulence of the virus, its ability to spread rapidly in indoor settings and the innate clinical vulnerability of care home residents.