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. This report is a revision of the report published on 28 October 2020. The Universities of Edinburgh and Glasgow were partners in the production of this report. The following revisions have taken place:

• Further quality assurance of the data used in this report, which has resulted in 6 discharges (3 individuals) being removed from the analysis. This is because these discharges were later identified as not being to a care home. All analyses have been updated to account for the changed data. This does not impact on the main conclusions from the original report.
• The reporting of the statistical modelling part of section 2 (which analyses the risk of care home outbreaks associated with hospital discharge) has been updated following feedback from users and the Office for Statistics Regulation. Additional visuals and commentary have been included to provide greater clarity on our findings.
• Section 3 has been added, incorporating further analysis.

The report is presented in three 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. Section three provides further analysis on: classification of discharges based on residency prior to their admission to hospital; analysis of the outcomes of all those who were discharged from hospital to a care home and analysis of those discharged from hospital to a care home whose last test was positive (including viral genomic sequencing).

Main points

• Between 1 March and 31 May 2020, there were 5,198 discharges from NHS hospitals to care homes (4,804 individuals), this accounted for 5.3% of all hospital discharges during the same period.
• There were 843 (77.8%) of the 1,084 care homes in Scotland that received hospital discharges between 1 March and 31 May.
• Using laboratory confirmed cases, 348 (32.1%) care homes in Scotland experienced an outbreak of COVID-19 in the home between 1 March and 21 June.
• In the statistical modelling analysis (see tables 10 and 11 for detailed commentary):
  • Hospital discharge is associated with an increased risk of an outbreak when considered on its own. It is important to note that after accounting for care home size and other care home characteristics, the estimated risk of an outbreak due to hospital discharge reduces. No statistically significant association was found between hospital discharge and the occurrence of a care home outbreak. However, due to the uncertainty observed, we cannot rule out a small effect, particularly for those patients who were discharged untested or discharged positive.
  • Care home size is much more strongly associated with the risk of an outbreak than other care home characteristics, including the different types (negative test, untested, positive test) of hospital discharge.
• There were 106 people (who had a total of 110 discharges) where the last test for COVID-19 before hospital discharge to a care home was positive. For these 106 people:
  • There were 80 people discharged to care homes with an existing outbreak of COVID-19, where the discharge could therefore not have caused the outbreak.
  • There were 7 people discharged 15 or more days after their first positive test for COVID-19, who would not be considered at risk of onward transmission of infection.
  • There were 9 people discharged to care homes which did not experience an outbreak of COVID-19.
  • There were 10 people discharged where the hospital discharge and care home outbreak showed an association in the timing of the hospital discharge and care home outbreak which required further review using viral genomic sequencing.
• Mortality is high among people discharged to care homes, with 675 people dying within 30 days of discharge (14.1% of all of those discharged), COVID-19 was associated with 21.6% of deaths within 30 days of hospital discharge.
• In the 30 days after their hospital discharge to a care home, 154 people tested positive for COVID-19 (3.5% of all people discharged who had not previously tested positive).
• Viral genomic sequencing analysis was only possible for eight hospital discharges where the timing of discharge and outbreak was potentially consistent with the discharge causing introduction of infection. The findings are not consistent with hospital introduction of infection in the care homes examined. However, only a small proportion of outbreaks could be examined.