Senior Discharge Coordinator

Job overview

The post holder will work with the Integrated Discharge Team Lead for the Whittington Hospital site, to facilitate the timely, effective, and safe discharge of patients from the acute setting. This will require close liaison with hospital, community, social and health service colleagues working to ensure the flow of patients is well managed with the aim of a positive discharge experience and appropriate transfer from hospital care to community care.

The post holder will play an important role in the education and development of staff across the Trust in relation to discharge planning. They will be required to work with key stakeholders to deliver the new guidance in the National Hospital Discharge and Community Support Policy and Operating Model.

They will promote and provide excellent discharge practices within the ward environment with a particular focus on “Criteria to reside” and “Home first”.

Main duties of the job

The post holder will support the training and development of ward staff to ensure best practice in planning safe and timely patient discharges to achieve best outcomes for patients as well as to optimise hospital bed utilisation and reduce length of stay.

The post holder will case manage a designated caseload and be required to work in conjunction with the multidisciplinary team to set realistic expectations in relation to discharge options with patients and relatives.

In conjunction with the Integrated Discharge Lead, the post holder will be expected to develop IDT team members giving support and advice and acting as a resource for all aspects of complex discharge planning. The post holder will also have operational and supervisory responsibility for staff groups within the IDT.

The post holder will also be required to deputise and operationally manage the team in the absence of the Integrated Discharge Lead.

The post holder will also be required to work collaboratively with our Flow Senior Discharge Coordinator and provide cross-cover for this role when required.

Working for our organisation

Whittington Health mission, vision and goals

We have an excellent reputation for being innovative, responsive and flexible to the changing clinical needs of the local population. We are treating more patients than ever before and are dedicated to improving services to deliver the best for our patients.

Our mission
Helping local people live longer, healthier lives.

Our vision
Provide safe, personal, co-ordinated care for the community we serve.

Our goals
We have developed six key strategic goals to make sure we continue to support people to live longer, healthier lives.

• To secure the best possible health and wellbeing for all our community
• To integrate and coordinate care in person-centred teams
• To deliver consistent, high quality, safe services
• To support our patients and users in being active partners in their care
• To be recognised as a leader in the fields of medical and multi-professional education, and population-based clinical research
• To innovate and continuously improve the quality of our services to deliver the best outcomes for our local population

Detailed job description and main responsibilities

Working Relationships

· To work collaboratively with the MDT in daily board rounds on the in-patient wards to identify potential problems at an early stage to prevent unnecessary delays, and promote good discharge planning practices

· In addition, with ward managers and nursing teams and address issues of concern as appropriate, ensure assessments are completed when required and on time, escalating delays as appropriate including the CHC pathway – being responsible for the support of wards with full and complete submission of documentation.

· To develop effective working relationships with CNS staff to ensure that clinical reviews happen in a timely way to support discharges. This may include but is not limited to; specialist nurses – dementia, diabetic, TVN, stoma, respiratory etc.; lead therapy staff, Ward managers and Consultants.

· To proactively support the MDT to manage complex cases to ensure patient’s do not become stranded in the acute setting.

· Work collaboratively with stakeholders across the health, social care, and third sector economy to optimize use of all services in support of getting the care for patients “right first time”. To address any shortfalls in the current systems to ensure the highest delivery standards and achieve patient satisfaction.

· To be a resource for the MDT in relation to all discharge planning related to homeless persons, vulnerable adults, and asylum seekers, fostering links with housing teams and navigators.

· Work with organizations that can offer impartial advice to people who will be funding their own care or placement. Liaise with services and/or homes to ensure timely assessment and completion of required documentation to facilitate discharge.

· Working in conjunction with the Patient Experience Team, and when required take the lead to ensure that there are effective mechanisms in place for the early resolution of complaints and concerns raised by patients / carers / relatives in relation to discharge.

· The post holder will also be required to work collaboratively with our Flow Senior Discharge Coordinator and provide cross-cover for this role when required.

Operational and Leadership

· To provide expertise in the performance and management of the functioning Integrated Discharge Hub.

· To deputise for the team in the absence of the Integrated Discharge Team Lead.

· To represent the IDT in the following meeting forums when required –MADE meetings, Bed and Escalation meetings, providing sit rep reports and escalating delays through established processes.

· Be responsible for allocating cases to the IDT case managers in the team.

· Be a case manager for patients with complex needs on discharge. Have full oversight of the case, ensuring that all necessary MDT assessments are completed and available to key stakeholders.

· To determine the relevant pathway for patients leaving hospital and work in partnership with other services (e.g., health, social services, community services and commissioners) to ensure the patient leaves via this pathway when the criteria to reside is no longer met

· Monitor the progress of those patients who have been declared medically optimised and who no longer meet the criteria to reside yet continue to occupy an acute hospital bed. Work proactively to ensure delays in providing the services the person requires or transfer to an appropriate destination are kept to a minimum.

· To advise on and implement the NCL Choice Policy and or the Facilitated Discharge Policy.

· To support the IDT lead when required with local, sector and national reporting requirements; collecting, analyzing, reporting, and auditing data as directed.

· Model the behaviors which promote the Trust’s values, including the promotion of a culture of equality.

· To undertake any other such duties as may be reasonably delegated from time to time as are consistent with the responsibilities of the grade, such as emergency on call and weekend rotas etc.

Person specification

Education / Qualifications

Essential criteria

• Educated to degree level or equivalent experience.
• Evidence of post basic continuing professional development

Skills & Abilities

Essential criteria

• Excellent verbal and written communication skills
• Proven ability to analyse complex problems and to develop and successfully implement practical and workable solutions to address them.
• Able to multitask, prioritise and continue to function to a high standard when under pressure
• Ability to demonstrate personal management skills including time management.
• Effective people management skills
• Ability to motivate staff in different settings
• Ability to demonstrate awareness of need for effective teamwork
• Computer literate (with ability to generate reports
• Ability to secure commitment from others to change programmes and able to use persuasion and influence to enthuse
• Excellent clinical and holistic assessment skills

Knowledge & Experience

Essential criteria

• Knowledge of the national best practice in relation to discharge system and processes, e.g., hospital discharge guidance, discharge to assess models.
• Significant experience in delivering care through partnership working.
• Knowledge and understanding of National Policy and drivers in Discharge Planning and Patient Flow across the whole health and social care system
• Knowledge and understanding of Clinical Governance and risk management systems.

Desirable criteria

• Knowledge and understanding of the operation of a major acute hospital, community trusts and across social care sector.
• Understanding and insight into health policy
• Experience of delivering teaching in an MDT setting
• Experience of quality and clinical audit

SAFEGUARDING CHILDREN AND ADULTS

To comply with the Trust’s Safeguarding Children and Adults policies, procedures and protocols. All individual members of staff (paid or unpaid) have a duty to safeguard and promote the welfare of children, young people and vulnerable adults This will require you to:

• Ensure you are familiar with and comply with the London Child Protection Procedures and protocols for promoting and safeguarding the welfare of children and young people.
• Ensure you are familiar and comply with the London Multi Agency Safeguarding Vulnerable Adults Pan London Procedures.
• Ensure you are familiar and comply with local protocols and systems for information sharing.
• Know the appropriate contact numbers and required reporting lines.
• Participate in required training and supervision.
• Comply with required professional boundaries and codes of conduct

Whittington Health is committed to safeguarding all children and vulnerable adults and expects all staff and volunteers to share this commitment.