Maybe one of you knows a bit about NHS admin?

[HarrietteVane]

I truly hope you all had a better Christmas than me, since mine featured DH in emergency surgery for 5 hours, which was a bit of a shock.😯

It also means we're stranded 200 miles from home as we were on a family visit when it happened. So that's a bit of a bugger.

We're OK to stay where we are for another week but after that the kids need to be back in school and I need to be with them. So possibly 200 miles away from DH, but within 3 miles of a very large and busy training university hospital.

Moving DH to our local 'home' hospital would be an obvious answer, but when I ask about a transfer I get mixed answers from the staff at the hospital - even the positive ones are not giving me any clues on what the actual process is.

So I guess...does anyone know if NHS can transfer patients between hospitals for non clinical reasons? And if so, how the hell it can be done?

First thing is that he would have to be stable enough for transfer, second (often more tricky especially at this time of year) there would have to be a free bed at the hospital they want to transfer him to. I would suggest asking to speak to the matron or ward manager on Monday.

yes it can be done. He needs to be well enough recovered to travel safely and the receiving hospital need to have beds and accept the referral. The teams will know how to do that and will be able to organise it when it's safe for him.

Yes absolutely. I would probably make an appointment to speak to the ward sister or your consultant.

They will be able to say if its possible as there needs to be specialists in your local hospital that would be able to oversee his care.

Also, do you need to be with him if he is getting better? When is he probably going to be discharged?

If it's another week or two, can you just go home and ask a relative where you were staying to pop in a couple of times with supplies?

Wow! See this is why I love Mumsnet, thanks @RenegadeKeeblerElf.

I think he's pretty stable - he's walking, on a drip, has a nasal tube that has to be aspirated when the pressure in his stomach is too much. But all obs look good, we're just waiting for the bowel and stomach to recover from open surgery to look for a bowel obstruction.

I get what you mean about bed availability. That's obviously going to be a significant issue.

Speak to the ward manager and his consultant. I hope he continues to improve.

Is there an option to pay for the transport? The NHS is really short of cash. if you offered to pay for a private ambulance that might help push things forward (if you could afford to).

@Thankgodxmasisover thank you! On the discharge front it's incredibly frustrating...he had open surgery for an obstructed bowel and it turned out there was no physical obstruction, just a lot of inflammation.

Although he recovering from the surgery like a champ the bowel and stomach have not started normal function yet and there seems to be no expectations on what is 'normal' for this process to restart. So DH is stuck on a drip and unable to make progress towards discharge.

Thanks @custardpyjamas that's a top tip. Maybe I should add it to DH's christmas present list.

Pretty sure the issue is going to be beds in our 'home' hospital, which is massive but also a regional centre so always swamped. Would be good to know how beds are allocated - if we have to rely on someone from the current hospital chasing for a bed then I think we're toast as they are all run off their feet poor things.

sounds like transferring might not be very pleasant for him so soon after a laparotomy and might not be that great for getting his guts working again. 200 miles in an ambulance isn't a minor undertaking and the risk of setting back his recovery needs to be weighed against the benefits of being closer to home. Really only his surgical team can advise about when it'll be a good idea to make the move.

Hi - so sorry to hear that this happened . I’m a surgeon in a holiday area and so we often get this type or issue.
What sort of surgery did DH undergo? , is he in critical care? Is he having ongoing problems?
This will influence how much longer he will need to be in hospital although it’s a bit unpredictable.

The most important things are that

1. DH should be well enough to comfortably travel
2. DH is making a good recovery and the risk of further complications is low ( in this period it is MUCH better to be where the team know exactly what has happened to manage complications / reoperate etc)
3. The receiving hospital has the right specialist area. Not all teaching hospitals have all specialities. He will need to be admitted under a surgical team rather than medical or rehabilitation team.
4. The receiving hospital has available beds in the right specialty. This is often a major point of delay as he will be seen as low priority. This is the busiest time of year for hospitals and the bed manager of your local hospital is allowed to prioritise patients waiting in their A and E and local community who are acutely unwell over someone recovering who needs repatriation.

Often by the time a bed is available the person is well enough to go home… Hope your DH continues to make a good recovery.

Honestly he does not sound stable if post surgery he still has his tube in, it's still being aspirated and his bowel isn't functioning.

Cross post … I wouldn’t push to transfer him in the next week OP.
You can’t begin the transfer process until someone is well enough to leave or at a place where the team would be happy for them to leave that day.

The bed manager of each hospital will liase.
Sounds like he will be out within 10 days and probably much sooner .

Ah, @Greybeardy now that is an interesting point. It's also a bit worse than that as they had to follow up the laporotomy with open surgery to thoroughly investigate the whole gut. Not that they found anything!

So no it would not be a fun ambulance ride, and I hadn't considered that it could further delay the return of gut function.

His consultant was pretty negative about a transfer last night but wasn't terrific about explaining his thinking, I wonder if that was his line of thought....

I'm beginning to think that this is a decision best made later in the week, which leads me to a further question for you sages: if we assume a bed is available (yes, I know, not likely), how long would be process take?

It’s really unpredictable how quickly his bowel will restart working , could be a day or two or 10 days , hopefully at the lower end of time.

I am sorry to hear this, we were on holiday when my DH needed emergency surgery abroad. Like you, we had children needing to return home for school. Our flights home were the same day as the surgery. My DH was stable as we returned home and left him to recover in a hotel with daily outpatient appointments.

It wasn't ideal, but your husband is receiving care and I would return home next week and collect him when he is discharged and it is safe for him to travel more comfortably.

I'm sorry that this has happened it midt be very difficult for you.

It's very difficult to predict when his bowel will restart normal function,

NHS hospitals do vary massively and have specialties in particular things so you'd want to be sure that there is a team for his issue at the receiving hospital.

In some people the bowel does not start normal functioning again - my dad had to have a stoma bag. In your shoes I would absolutely prioritise him staying where he is, to be with his original medical team.

I hope he is well soon.

Sorry to be negative but I would work with the idea that DH will not be transferred. I can’t imagine that his surgeons will think it is a good idea to transfer before Friday . Once he is more well they will be working on straight home as is usual .
If you do ask for a transfer when he is reasonably well the wait will be a minimum of 3 days and maybe up to 7 at this time of year.

He will be home sooner !

Hi, we do transfers all the time. It’s called repatriation. The hospital he’s in now will want him repatriating as soon as he’s well/stable enough as it gets them a bed back. The hospital repatriating too will have to find him a bed.

so how this happens is once he’s stable enough, the consultant will refer him to your local hospital consultant, often by telephone but sometimes electronic referral or email. Or heaven forbid, fax. The patient flow team will also need to make the other hospitals patient flow team aware.

your local hospital, once the patient is accepted by the consultant, will have him on the “repat list” to bring into that hospital. The bed managers/flow team have to try and allocate him a bed amongst those due in electively for surgery plus those in ED. It can take a while.

If the consultant isn’t sounding too positive try and find out why and what your husband needs to do to be ready to go. As a PP said, book a meeting with the consultant, and or ward manager to initiate these convos/plans.

good luck! Xxx

Oh and to add, it may be quicker for him to be discharged than transferred. If he’s otherwise fit and healthy, and he’s recovering well he shouldn’t be in long

@olympicsrock you star, thank you very much. And I do get your point, I think I am beginning to see the reason why this is a tough question for the ward team to address.

DH was very fit (marathon runner) and well before the surgery. And apart from the bowel function appears to be recovering very fast. He's out of critical care and on a general ward, where they are doing regular obs and keeping an eye on drips, aspiration from the NG tube.

So if we were to see a return of bowel function then I think we'd be looking at a pretty rapid discharge. However that's very slow and I can't find any information anywhere on what is a 'normal' period of time for this to recover. So we're feeling a bit in the dark.

My advice would be to hold tight, he might be allowed home in another week. I had a similar bowel operation and I was out 16 days after surgery. If he has to stay there another few days and you go back to sort the kids I would do that.

Then when it’s time for you to bring him home, you are just going to have to take it very steadily with lots of stops and make it as comfortable as possible.

This sounds horrible but if he's stable and improving perhaps he can do without you, especially if you were in a family visit is there someone nearby who can do some visiting?
Or someone who could swap to babysit the kids and you could return over the weekends? I'm aware 200 miles is not a small distance to go back and forth though!

I have previously worked in discharge (purely admin, not medical) and the transport aspect can be very tricky, in my experience.

Transport teams often cover multiple locations in the same trust/area. You can book them for a date and time but they will often be called off for an urgent transfer, that quite rightly takes priority over a repat. This results in, understandably, very disappointed patients/families so please do keep this in mind.

The other thing is the time of year, the transport team will likely have less staff than usual so will be less likely to be in a position to commit to taking a crew out of action for a non-emergency 400 mile round trip.

Again, this is just my experience with one specific NHS trust, and they can vary widely depending on the area you are in.

A fax!!!!!

Sorry, missing the major point I know, but really? `That's both horrifying and hilarious.

Thanks @Catsonskis, it's really good to know the language and process. I think I'm now beginning to brace myself to have the conversation with DH around how it would be better to wait for his gut to get going so he can be discharged normally. @olympicsrock has summed things up pretty well.

It's difficult because he is exhausted, anxious and doesn't completely trust the team on the ward he's in (they're under pressure, they've made a few small mistakes which I've had to catch). So I will have to support his reactions, but he is quite scared of the idea of staying there without me around.

Hmm honestly I wouldn’t really be pushing for transfer in this situation. If it were something a bit more straightforward, eg he had pneumonia and just needed a few more days of antibiotics, that could very reasonably be done in another hospital. But your husband has had two emergency surgeries, been in critical care, and still sounds fairly poorly. I wouldn’t underestimate the value of being under the surgical team who admitted him, have operated on him, and know all the findings and reasoning behind why things have been done. If he transfers to another hospital he’d lose all that, and I’d be worried things may get missed or any potential issues would take longer to spot. In your shoes I’d probably just sit tight in the original hospital.