Discharge Coordinator

Job description

Job responsibilities

Role Summary

To ensure smooth, safe, and person-centred transitions for patients through The Kirkwoods clinical services, maintaining consistency and person-centred approaches.

What Youll Do:

• Work closely with patients, families, and our inter-disciplinary team to plan and coordinate timely discharges and admissions.

• Liaise with the inter-disciplinary team, external agencies, community services and care providers to ensure continuity of care.

• Advocate for patients needs, preferences, and wishes throughout the discharge process.

• Maintain accurate records and contribute to ongoing service improvement.

Work with the rest of the in-patient unit (IPU) and community services to proactively coordinate discharge from the inpatient hospice unit when required as well as preparing for admission.

Primary Responsibilities

Coordinate complex discharges, in collaboration with the Inter-disciplinary team

Act as discharge support to individual complex discharges, working responsively to rapid changes in life limiting and palliative care needs.

Assist and support the inter-disciplinary team to drive and co-ordinate patient flow, ensuring effective, timely intervention from all disciplines to ensure safe and effective discharge planning in conjunction with patients and families.

Assist IPU and community services to develop and implement effective discharge plans supporting patients and families and ensuring all care and services are in place prior to discharge if needed, identifying and working with the inter-disciplinary team to resolve any issues.

Organise family/planning meetings with the lead professional negotiating with all possible attendees including patients, families and external agencies as well as internal staff members.

Advocate for patients needs, preferences, and wishes throughout the discharge process.

Work with multi-agency representatives to reduce any delays related to discharge.

Consider budgetary implications with regard to basic equipment required for discharge.

Identify size and frequency of care packages required for discharge, and whether provision is possible in the preferred place of care or preferred place of death.

Consider alternative means of provision of care and explore options.

Working effectively internally and externally

Communicate effectively and sensitively with all internal staff, external organisations, patients, relatives/friends and the general public.

Hold complex and emotional conversations in relation to advanced care planning and preferred places of care or death in relation to life limiting health conditions.

Support transfers to community venues/services.

Participate in accurate, up to date communication and documentation.

Attendance at weekly inter-disciplinary team meetings as requested to support discharge planning.

Developing internal knowledge base

Act as a central point of contact for discharge planning acting as resource for knowledge of the discharge planning processes, services available and how to access them.

Provide education in discharge planning to members of the inter-disciplinary team or other professional groups, as required, including delivery of training courses.

Support the in-patient unit and community service in its understanding of current discharge practice.

Monitor performance associated with discharge, identifying gaps in service provision that may have a detrimental effect on length of stay, delayed transfers of care or patient experience.

Understand and work with the social work & therapy teams to support all aspects of discharge planning and financial assessment.

Ensuring compliance

Facilitate compliance with current legislation relating to discharge planning and Home First Model.

Ensure compliance with Continuing Healthcare and act as a facilitator between teams as appropriate.

Other Responsibilities

To work in accordance with the values of The Kirkwood. Patients, Families and Carers are the focus of everything we do. Our values are what we live and work by.

We are:

Respectful and Inclusive

Passionate and Determined

Open and Honest

Kind and Compassionate

Forward-thinking

We strive for Quality and Excellence

To participate in The Kirkwoods performance and development review process.

To undertake any other duties required by The Kirkwoods Management team commensurate with the post.

To undertake annual mandatory training provided by The Kirkwood.

To maintain complete confidentiality as a condition of employment. Information relating to patients, other members of staff and volunteers or which is acquired for the purposes of employment may only be disclosed with the express permission of the appropriate manager.

To respect the ethos and values of The Kirkwood and its services and comply with its policies, procedures and regulations.

This job description is not exhaustive therefore the employer and employee share responsibility to review and amend this job description in order to reflect any changes in role/development.

Person Specification

Qualifications

Essential

• NVQ Level 3 in Health and Social Care or equivalent
• Full driving licence and access to own car with insurance for business purposes

Experience

Essential

• Experience working as a Discharge Coordinator, Care Co-ordinator or similar role focusing on arranging discharges
• Experience working in/with a health and social care multidisciplinary team
• Recent experience of working in a health and social care setting
• An understanding of the needs and issues concerning life limiting illness and disability
• Basic working knowledge of:
• a) Mental Capacity
• b) Social Care

Desirable

• Experience or working with people at challenging times in their lives
• Experience in complex discharge planning within a Home First Model
• Experience of completing needs-based assessment with service users or carers resulting in provision of services
• Experience of using patient records
• An understanding of working with financial implications and constraints, ensuring cost effectiveness
• Knowledge of palliative care and/or community health services

Skills & Abilities

Essential

• Good communication and interpersonal skills to establish and maintain relationships
• Ability to empathise and reassure
• Good written communication skills
• Ability to motivate others
• Be able to use basic IT systems effectively, eg for writing minutes, using letter templates, recording patient information and communicating
• Excellent time management and organisational skills, including ability to co-ordinate activities with numerous stakeholders
• Ability to work within clearly defined policies and procedures
• Ability to work effectively in a team and thrive in a collaborative environment.
• Demonstrate a clear understanding of the need to balance compassionate care with the responsible and efficient use of resources for discharge
• Demonstrate a strong, proactive interest in the discharge planning process and its impact on patient outcomes

Disclosure and Barring Service Check

This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.

Certificate of Sponsorship

Applications from job seekers who require current Skilled worker sponsorship to work in the UK are welcome and will be considered alongside all other applications. For further information visit the UK Visas and Immigration website (Opens in a new tab).

From 6 April 2017, skilled worker applicants, applying for entry clearance into the UK, have had to present a criminal record certificate from each country they have resided continuously or cumulatively for 12 months or more in the past 10 years. Adult dependants (over 18 years old) are also subject to this requirement. Guidance can be found here Criminal records checks for overseas applicants (Opens in a new tab).

Employer details

Employer name

The Kirkwood

Address

21 Albany Road

Dalton

Huddersfield

HD5 9UY

Employer's website

https://www.thekirkwood.org.uk/ (Opens in a new tab)