University Hospitals Dorset NHS Foundation Trust

3. Mr R complains the Trust should not have discharged his father, Mr S, from its care in October 2024 because he was still unwell with pneumonia which needed hospital treatment.

4. Mr R explains his father deteriorated at home after discharge and returned to hospital the next day. He says his father died a few days later and he wonders if his death was avoidable. He told us he and his brother were traumatised by the chain of events.

5. Mr R is seeking a financial remedy, apologies and service improvements.

6. Mr S was in his nineties. He became unwell in October 2024 and his GP had started antibiotic treatment for a suspected urinary tract infection. Mr S was generally unwell and, when he developed a fever and started working harder to breathe, his family called for an ambulance. The Trust diagnosed pneumonia and Covid19, and admitted Mr S to the Trust’s Older Persons Assessment Unit for treatment.

7. A few days later, the Trust thought Mr S was doing better and discharged him. After he returned home Mr S unfortunately deteriorated again overnight. The Trust readmitted him the next day and sadly he died in hospital a few days later.

11. Mr R complains about the Trust’s decision to discharge his father on 27 October. The Trust said that on the day Mr S had clinically improved, he no longer required oxygen therapy, and his vital signs were within normal limits.

12. DHSC statutory guidance ‘Hospital discharge and community support guidance’ (DHSC guidance) explains the general conditions for discharge from hospital to home. The relevant section includes a list of questions. If the answer to every question is no, then DHSC says active consideration for discharge to a less acute setting must be made. Of relevance to Mr S, these questions included whether he:

• needed oxygen?

• needs intravenous (into the vein) fluids?

• has a NEWS2 score greater than 3? NEWS2 is a tool which assess how ill a patient is by measuring breathing rate, temperature, blood pressure, heartrate, and how conscious the patient is. A higher score means a person is more ill.

• needs intravenous medication more than twice a day?

13. There are more specific discharge recommendations for patients with pneumonia in NICE clinical guideline CG191 ‘Pneumonia diagnosis and management’ (CG191) section 1.2.19 ‘safe discharge from hospital’. This says adults with community-acquired pneumonia should not be routinely discharged if in the past 24 hours they have had two or more of the following: • temperature more than 37.5°C • respiratory rate 24 breaths per minute or more • heart rate more than 100 beats per minute • low blood pressure • oxygen saturation of less than 90% on room air • abnormal mental status • inability to eat without assistance.

14. Mr S’s records show doctors planned to discharge Mr S when his oxygen levels improved and he was weaned off oxygen and onto room air. This is in line with DHSC guidance and CG191. They also wanted an assessment by an occupational therapist so support could be put in place when he returned home.

15. The day after this plan was put in place, nurses monitored Mr S regularly. When his oxygen levels began to improve, they started to wean him off oxygen by slowly reducing the amount he was given. An occupational therapist reviewed Mr S, as planned. They felt he was back at his baseline (his usual function) because he could stand up, transfer between furniture, and generally move independently.

16. The next day the Trust discharged Mr S. By this point he was alert, he had been off oxygen support for a full day, and his observations (heartrate, blood pressure, oxygen levels, consciousness, and temperature) were stable. At this point the answer to each question in DHSC guidance was ‘no’, so the Trust had to give active consideration to discharging Mr S. He also met the discharge criteria in CG191. This means we see no indication the Trust was wrong to discharge Mr S when it did.

17. We asked our adviser to consider whether Mr S still needed hospital treatment at the point he was discharged. The priority for doctors was treating his pneumonia. Mr S also had Covid-19.

18. For pneumonia treatment, doctors needed to follow the guidance in NICE guideline NG138 ‘Pneumonia (community-acquired): antimicrobial prescribing’ (NG138) section 1.2 ‘choice of antibiotic’. This sets out a number of antibiotics which can be used to treat pneumonia depending on its severity. Doctors prescribed a five-day course of doxycycline, which CG121 suggests for moderate severity community acquired pneumonia.

19. NICE guideline NG191 ‘Covid-19 rapid guideline: managing Covid-19’ (NG191) section 4.3 ‘Corticosteroids’ explains that doctors should offer dexamethasone (a corticosteroid which treats inflammatory conditions) to people who need supplemental oxygen to meet their prescribed oxygen needs. Mr S was in this category, and doctors treated him appropriately with dexamethasone.

20. The Trust discharged Mr S with antibiotics to take along with his usual medications. Our adviser saw no indication that he still needed hospital treatment at this point. This means we have not seen any indications of failings in the Trust’s decision to discharge Mr S when it did.

21. Mr R was understandably concerned when his father unfortunately deteriorated again so rapidly at home and he - quite rightly - contacted 999 to have him readmitted to hospital. We know he was concerned the Trust acted prematurely or missed something in its care of his father. We hope he is reassured we saw no indication this is the case.

1. We have carefully considered Mr R’s complaint about the Trust. We have seen no indication that anything was wrong with the Trust’s decision to discharge his father, Mr S, when it did.

2. We are sorry to learn Mr S became unwell again and sadly died. We know Mr R’s concerns about the discharge have caused him to wonder if his father would still be alive. We recognise this was a difficult time for Mr R and we hope he finds our explanations helpful.