Discharges from NHSScotland hospitals to care homes
Between 1 March and 31 May 2020

About this release

This publication by Public Health Scotland (PHS) presents management information statistics on people aged 18 and over who were discharged from an NHSScotland hospital to a care home between 1 March and 31 May 2020. The report is presented in two sections. Section one of the report explains the methodology in defining the cohort of patients who were discharged, and describes their demographics and COVID-19 testing status. Section two defines and describes care home outbreaks of COVID-19 with an analysis of the factors associated with those outbreaks, specifically including hospital discharges.

Main points

• Between 1 March and 31 May 2020, there were 5,204 discharges from NHS hospitals to care homes (4,807 individuals), this accounted for 5.3% of all hospital discharges during the same period.

Source: Validated register of hospital discharges to care homes

• There were 3,599 discharges from hospital to a care home between 1 March and 21 April. The majority (81.9%) of which were not tested for COVID-19, in-keeping with clinical guidance which restricted testing to those with symptoms of infection. Of the 650 who were tested, 78 received a positive result while in hospital.
• There were 1,605 discharges from hospital to a care home between 22 April and 31 May. The majority (1,493, 93%) were tested for COVID-19, in line with the changes in clinical guidance. Of these, 1,215 tested negative and 278 tested positive. Of those who tested positive, 233 had a negative test result prior to discharge.

It is important to note that there are valid clinical reasons for individuals not to be tested prior to discharge, relating to their capacity to consent to testing and avoiding causing distress, and to appropriateness of testing, e.g. in end of life care situations.

• 843 of the 1,084 care homes received hospital discharges between 1 March and 31 May.
• Using laboratory confirmed cases, 348 (32%) of care homes in Scotland experienced an outbreak of COVID-19 in the home between 1 March and 21 June.
• In the statistical modelling analysis:
  • Care home size has the strongest association with outbreaks of COVID-19, and this association persists after taking account of other care home characteristics including discharge from hospital. Risk of a care home outbreak increases progressively as the size of care home increases
  • Hospital discharge is associated with an increased risk of an outbreak when considered on its own. However, after accounting for care home size and other care home characteristics, the estimated risk of an outbreak associated with hospital discharge reduces and is not statistically significant.

Background

On 18 August 2020 the Cabinet Secretary for Health and Sport, commissioned PHS to carry out this work and to publish the findings. Both the University of Edinburgh and the University of Glasgow were partners in the production of this report.