Patient discharges at Christmas

Hospitals can be dull at the best of times for patients but especially so at Christmas, and this can put doctors under pressure to authorise early discharge.

Telephone advice sessions often lead to interesting discussions. Recently, a member highlighted an area of concern he had noted on a significant number of occasions when producing medico-legal reports.

Acting as an independent expert allows objective analysis of the various scenarios resulting in claims for negligence. This particular expert commented that in the approach to Christmas there were a disproportionate number of claims where patients had been inappropriately discharged from hospital.

Patients obviously want to be in the comfort of their own homes with family and friends at Christmas time. Hospital can be very dull at the best of times. When compared with festivities at home it is a particularly unattractive place to be. This leads to a great deal of pressure being applied by patients and their relatives for either early discharge or a period of home leave.

Not surprisingly, this can lead to a tendency to succumb to the patient's wishes. It is essential to exercise caution in these circumstances and standards must not be reduced in order to satisfy the patient's demands. If patients would not usually be discharged in the same circumstances - i.e. if Christmas is taken out of the equation - they should not be discharged. Normal clinical judgement and acumen must be applied. A happy Christmas is not one where a patient comes to harm because of a kindly but ill-judged premature discharge.

We see this in a variety of situations where emotional pressure is brought to bear and thereafter clouds clinical judgement. Resisting patients' requests can be extremely difficult but all too often things do not go well and the doctor is left facing an indefensible situation. This not only leads to claims but can also lead to serious GMC complaints. Because doctors are acting against considered good judgement and practice, the risks of adverse occurrences are greater. If something can go wrong it is more likely that it will.

Christmas is a particular focus of this type of pressure, especially with the neighbouring New Year holiday. Be aware and act with caution when determining which patients should be discharged.

ACTION: Only discharge patients who meet your usual criteria for being fit for discharge. Do not let emotional pressure cloud your judgement. If you do so you are putting patients at increased risk of harm and yourself at risk of legal claims and professional disciplinary action. By exercising care you can ensure that both you and your patients have a happy Christmas.

Dr Gail Gilmartin, medical adviser, MDDUS