Specialist Discharge Coordinator

As a Discharge Case Manager, you will be aligned to specific hospital inpatient areas and will be responsible for a case load of patients at all levels of complexity to progress their hospital journey from admission to discharge.

You will play a vital role within hospital flow and be the escalation point to progress the patients’ hospital journey and in turn facilitate a timely discharge with the aim to meet every patient’s Estimated Dates for Discharge (EDD) with the overall objective to reduce the hospital length of stay

Ensure that patients, relatives and carers are provided with information about discharge planning and have that information explained, so that they can be supported in their decision making to help promote and enable independence in a timely manner

To participate in a new Pathway 1 Discharge Pathway across local boroughs; working closely with the hospital social work team and community teams to refer appropriate patients for bridging packages of care. This role includes completing these referrals and co-ordinating the discharge of non-complex pathway 1 patients, ensuring they are discharged home in a timely manner.
- In liaison with ward staff, community, social services and other healthcare colleagues facilitate timely, appropriate and safe discharge of patients.
- Act as a trusted assessor for care homes and community bed settings by completing the initial discharge conversations and all relevant discharge paperwork.

Complete initial discharge conversations with patient and their families to determine home situation and any concerns

Ensure Early Discharge Notification (EDN) to be completed within 24 hours of hospital admission,

Needs Based Assessment (NBA) and any other onward referrals are completed in a timely manner

Assist ward staff to complete Fast track paperwork Accordingly

become P1 pilot coordinator to complete phone referrals to the appropriate Home 1st teams
- Work as part of the hospital-based discharge team to ensure standards relating to discharge practice

Chelsea and Westminster Hospital NHS Foundation Trust is proud to be one of the top performing and safest trusts in England. We have two main acute hospital sites—Chelsea and Westminster Hospital and West Middlesex University Hospital, plus our award-winning clinics across North West London and beyond.

**Responsibilities**:
In liaison with ward staff, community, social services and other healthcare colleagues facilitate timely, appropriate and safe discharge of patients.
- Act as a trusted assessor for care homes and community bed settings by completing the initial discharge conversations and all relevant discharge paperwork. Ensure that the Early Discharge Notification (EDN) to be completed within 24 hours of hospital admission, Needs Based Assessment (NBA) and any other onward referrals are completed in a timely manner
- Work as part of the hospital-based discharge team to ensure standards relating to discharge practice are evidence based (in accordance with the HCPC/NMC Code of Professional Conduct, and The Trusts Discharge Policy. Proactively support the coordination of patients on pathway 1.
- Ensure all Clinical systems are kept up to date, these include Cerner, Discharge Dashboards and Optica throughout the day
- Actively promote awareness of safe discharge processes for patients and their carers to prevent re-admission to hospital.
- Actively support and facilitate the transfer of patients who are privately funding their care to prevent extended length of stay. To adhere to the National and Trust Policy for Discharge to family and carers within the agreed time frame to avoid extended length of stay.
- To provide support and advice to pre-assessment clinics in the identification of potential discharge problems and generate solutions; thereby facilitating early discharge and potential need for multi
- disciplinary involvemen.
- Attend Daily Reason to Reside Meetings, MDT meetings, Professional and family meetings, Daily Board rounds on allocated wards. Promote the use of estimated date of discharge and reinforce within the multi-disciplinary teams; the need to ensure that all patients and carers are advised
- Ensure the person and any carer’s, family or friends are involved in and informed about all aspects of the discharge process
- Promote nurse led discharges at weekends and assist on competency levels to empower staff both at ward level and within the discharge team
- To have a good knowledge and understanding of mental capacity and deprivation of liberty legislation and other legal frameworks.
- In the event of a major incident, support the immediate transfer and discharge of patients to facilitate capacity
- Training For Ward Staff on Discharge Process
- Seek feedback from patients and carers.
- Develop and maintain own competence in agreed basic and advanced clinical skills relating to discharge processes