Our virtual event took place on Thursday 22 July 2021.
Presentations and videos from the event can be found here
The Discharge Lounge provides a calm environment for patients on the day of discharge in which to wait for medications to take home(TTOs), to be picked up by family or friends, or to be collected by hospital transport. The Discharge Lounge is open from 8am and closes at 7pm. The nurses and carers within the discharge lounge will provide refreshments including a hot meal at lunchtime as would be provided on the ward and there is access to toilets.
It is the expectation that patients will vacate their bed on the ward as soon as they are able and wait for final arrangements to be completed while in the Discharge Lounge, any clinical exceptions to this will be agreed between the nurse in charge of the Discharge Lounge and the Nurse in charge of the ward. Transferring to the discharge lounge helps the ward nurses prepare for the arrival of the next patient who needs care on the ward.
To maintain dignity it is important that patients are clothed in this area, and it is important to consider that all patients leaving hospital should have warm clothes and outdoor shoes provided from home to enable them to have a comfortable journey.
| Site | Where | Contact |
|---|---|---|
| BNHH |
A floor within the therapies department. |
Matron Kay Bennet ext 43187 (01256 473202 ext 43187) |
| RHCH | B floor alongside Therapy Services, opposite the Chapel. |
Matron Mark Badham ext 28916 (01962 828916) |
The complex discharge team comprises nurses and discharge practitioners who specialise in supporting the discharge of adult patients who have the need for ongoing care. The team works alongside community partners such as adult social care, Southern Health and Continuing Healthcare to help identify the most appropriate support for discharge, for example the team may be involved if the patient needs to have a package of care at home, ongoing rehabilitation or may have to move to permanent placement. The team is available from 8am until 4pm Monday to Friday. The complex discharge Team assists adult patients across the Trust, and has a base in Winchester and Basingstoke (The Basingstoke team also covers Andover War Memorial Hospital).
| Are | Contact |
|---|---|
| Basingstoke |
Team Leader - Andrea Kent 01256 486727 |
| Winchester |
Team Leader Hayley Collyer Contact 01962 824212 |
Discharge to Assess
Covid-19 Hospital Discharge Service Requirements (March 2020) direct that patients must not stay in a hospital bed once they are no longer acutely unwell.
The ambition is that patients continue to recover at home with support if required, if there is a need for a more intensive recovery period they may be transferred to a community setting.
Assessments are continued away from the hospital.
In this area of Hampshire if patients cannot immediately cope at home we have options for them including community hospitals, extra care housing, re-ablement facilities , a hotel and nursing/residential homes with added therapy input.
Under the current Covid Legislation there are no financial assessments; patients are cared for free of charge.
What is the D2 A process?
As soon as the person no longer requires consultant level of care, the registered nurse and therapist should complete the Single Assessment Tool (SAT) and submit it to the SAT inbox, this is all on EPR.
It is important that there is a comprehensive account of the person’s needs as this SAT replaces the nursing and therapy assessment documents as well as intervention charts and so it needs to have enough detail so that a stranger could pick it up and give the correct care to the person even without knowing them.
Choosing the discharge destination and level of care is the responsibility of the SPOA MDT although this is guided by the pathway which is recommended on the SAT by the ward MDT. It is important that this decision is supported by the ward team so that the person and family do not receive conflicting messages which will lead to confusion and distress. The ward team can give the assurance to the patient and family that this decision will be reviewed within a short while to make sure that it remains the right care in the right place for the person. The representative from the SPOA MDT will work with the ward and family to ensure that where possible the placement is acceptable to the family, for example taking into account any transport difficulties an elderly spouse might have, however the overriding ambition is to move the person out of hospital within a couple of days of being fit to leave- the same day if possible.
Conversation
Q why are we doing things differently now?
A this work was initiated as a response to the national Covid emergency. There are good aspects of this process that we would like to carry forward even when the crisis is over.
Q what is so good about D2A?
A within this process the person who has been ill is given a great opportunity to recover in a quieter environment away from the hustle and bustle of the ward. D2A recognises that people are more likely to participate in their own recovery in their own environment- so we get them home with support as much as we can.it also means that as patients are not in hospital longer than they need to be they aren’t deteriorating physically, and we also have the chance to move newly admitted acutely unwell people to the right wards.
Q Are people expected to pay for their care? Nursing homes can be expensive.
A under the Covid regulations the person does not have to pay for their own care while the Covid crisis continues. There is no need to decide who is paying for care before discharge; this includes everyone, whether they would previously have been paid for by Continuing Healthcare, Social services or using their own savings.
Q what can I do if I feel strongly that my patient needs a particular type of care on discharge?
A the best thing you can do is to make this very clear on your SAT. Try not to mention your thoughts to the patient or family because this may make it muddly for the person, but whatever you think would influence this decision, for example If you feel that a person is confused, or has fallen, or the wife is very anxious – or anything that would be helpful- document on the SAT. Also remember that if you feel someone is at the end of their life- document that this person in your opinion would have qualified for Fast track Funding. This helps further with the SPOA decision making, in this situation, document on the SAT that the person would have a preferred place of care such as home or Nursing Home.
The Single Assessment Tool was developed following a prolonged dialogue with stakeholders. It is used for all supported discharges on Pathways 2, 3 and 4 within HHFT It is also useful for pathway 1 restart and return if there seems to be an increase in care needs or a change in the person’s circumstances. It is helpful for the care agency or care home to be made aware prior to discharge of any changes in need; this will not slow down discharge but will ensure that the person is discharged into the right circumstances.
The Sat must be completed by someone with a registration, be that nurse or therapist as it is a legal document and reflects a clinical assessment of need.
The Single Assessment Tool is on EPR under electronic forms for the individual patient. It is submitted to the SAT inbox as soon as the person is ready to leave hospital. The SAT is then verified by the Complex Discharge Team and when they feel that there is all the information required to give good indication of the care needs of the person they submit the SAT to the Single Point of Access (SPOA). The SPOA MDT looks at each SAT as it comes in, with a formal review twice daily 7 days a week and decisions are made about the best care that can be offered to the patient.
Further advice or training on the SAT can be offered by the Complex Discharge Team.
Q there seems to be a lot of information required on the SAT, can I skip some of it if I don’t think it applies?
A. this would not work well. If you think an area is of no concern, put some explanation in, otherwise the person reading it does not understand if there is something that has been forgotten. For example - Breathing- do not write N/A or none! Better to take a moment and record that the person breathes independently on room air. Continence- do not write N/A or none! Jot down that the person is able to ask to use the toilet, that they can manage with supervision. If there is a catheter- Why? What type? When will it need changing? Wound care- what/where/what? What is the presentation, how often are you redressing it and what are you using?
Q If a patient becomes fit over a weekend should I send the SAT first thing Monday morning?
A no, please send the SAT as soon as possible we may be able to move the patient out of hospital on the Saturday or Sunday and have them settled back at home.
Q can I start the SAT and then finish it later?
A Yes, or it can be added to by various members of the MDT depending on who has the information. Don’t forget to submit the final one though!
Q why is does the SAT have an extra part on for West Berkshire?
West Berkshire require a care plan to start the care for the patient. This means that the initial visit for the patient at home may be from an experienced carer rather than a registered clinican. This care plan is therefore a requirement of the CQC for West Berkshire.
Single Assessment Tool Creation Pathway 1 - Berkshire example
Single Assessment Tool Creation Pathway 1 - Fast track POC
Single Assessment Tool Creation Pathway 1 - Increase POC
Single Assessment Tool Creation Pathway 1 - New POC
Single Assessment Tool Creation Pathway 1 - restart Hampshire
Single Assessment Tool Creation Pathway 2 - general rehab
Single Assessment Tool Creation Pathway 2 - orthopaedic rehab
Prior to Covid we had a policy for Discharge which included a section on ‘Choice’. The Choice policy was brought in if it was felt that the patient or relatives were delaying discharge in some way, it clearly reiterated the requirement to make a decision about placement or care provision so that the person could be discharged. Currently there are limited options as to what is available and the SPOA MDT directs this within the Covid regulations. It is up to the hospital MDT to support this. It is important to see the discharge process as flow and this may be helpful for patients and families. It is the expectation that we should not need the Choice Policy now as people are leaving hospital when fit to go under the Covid regulations- although the policy is available if required.
How can the ward MDT help a patient to be discharged safely?
The ward team plays a very important role in discharge. By understanding the referral and discharge process all assurances can be given to the patient and family. Ensure that the SAFER principles are followed so that all people are moving towards recovery and discharge each day, and escalate as per protocols any clinical or process delays so that they can be resolved.
SAT
An MDT approach to the SAT with very full information will guide any decision making from the SPOA MDT. Submit this in a timely way.
Medications
Ensure that as the TTOs are prepared; remember you may need 4 weeks worth of medications for some areas, talk to the Complex Discharge team or Community Link Matron for more advice. If you think it is a new care package and may require a NOMAD, please talk to pharmacy as many care agencies do not require NOMADs now, and CRT will work with bottles/blister packs to see how well the person manages. Try and get the TTOs onto the ward the day before discharge.
Dressings and equipment
Be clear on your SAT referral what is essential for discharge, other needs will be assessed later on. Provide enough equipment and dressings to last for 2 weeks, it may take this long for the community teams to get a repeat prescription, include a spare catheter if needed.
Transport
If someone is going home on a stretcher, please liaise with SCAS asap to complete an access visit. This does not need to be done on the day of discharge. It is stored on the SCAS database and it may be that the person has had one previously.
Communication
Communication is fundamental to safe discharge. It is the expectation that a handover between the ward and care provider takes place and that this is documented on EPR. The SAT can be completed with up to date detail about blood sugars/medications etc and sent with the patient to further support the discharge.
Please use this guide - Admission criteria matrix when referring patients to rehabilitation locations.
The Trust has changed the discharge pathways in line with National policy on 8th December 2021. We will be moving from 4 discharge pathways 0 – 3, to having 17 subcategories to clearly define the discharge service and destination of the patient.
