The press are today full of comment about hospital hotels, a new – at least new to the UK – initiative to use hotels as a half-way house for patients not quiet well enough to go home but good enough to move be moved out of a hospital ward.
It’s an idea predictably popular with Government and with the Department of Health since it frees much-needed hospital beds and todays news reports presumably represent a concerted political manoeuvre to test the waters of public opinion.
Hospital hotel transfers have been used in several countries already, most notably in Scandinavia, though an early trial at UCH London resulted in the unexpected and particularly embarrassing death of a patient while billeted at the local hotel.
Patients will not be placed into hotels just to recover in peace and quiet, but will continue to receive treatment, as self-care, by returning to the hospital as an outpatient, or using community care services visiting the patient in their hotel room. In the event of care being delivered in the hotel – wound care, drug administrations including a range of IV drugs perhaps with cytotoxics, that must be administered under on-going supervision, a predictable waste management issue is created, for the safe disposal of used sharps, pharmaceutical wastes and the containers that held them, and of soft clinical wastes.
Are these managed by the hotel care team, who may take the attitude that waste management is not part of their duty, as has been the case with a large proportion of community care staff? Or perhaps its the hotel housekeepers who will be expected to manage clinical wastes? Or the patients themselves, furnished with suitable containers and instructed to shuffle back to the hospital every now and again to dispose of them?
I imaging that this is a problem, a small but significant problem, that has not properly been thought through. A fudge seems to be the likely solution, with limited or minimal effort put toward proper waste management that will end in tears when hotels are prosecuted for waste management infractions that are not really of their making, or worse of hotel residents complaining – inevitably to the press – about the various waste finds that occur as they check in to their rooms!
It may be a somewhat longer wait, but there is every possibility that these will be followed by concerns about more general hygiene, for the hospital guests and for hotel patients nursed in an environment that is neither designed nor constructed for rigorous hygiene management. Will infections increase as a consequence?
These are not insurmountable problems, but who will make the effort?