Discharge Coordinator – Integrated Discharge Team
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Job summary
The post holder will be a key member of the multidisciplinary health and social care Integrated Discharge Team.
The post holder will be instrumental in the identification, assessment and discharge of patients with complex needs from the hospital setting, agreeing the discharge pathway and services including home and bed based reablement services, urgent community response (UCR) services including admission avoidance /Virtual Wards and community teams. The post holder will co-ordinate and navigate the patient across pathways to ensure timely discharge for patients deemed fit for discharge.
The post holder will work within the integrated team discharge providing skilled community focused approach to discharge planning and assessment, embracing the principles of Discharge to Assess Model and providing a person-centred approach to care.
Main duties of the job
Main Responsibilities
- Works without direct supervision, autonomously managing a caseload of patients.
- Work directly with the ward clinical team including medical staff, nurses, allied health professionals and support staff to discuss, agree and record the patient's pre -admission and current level, identify and assess patients requiring support services or advice for discharge.
- Assess and issue equipment for discharge in line with the competency framework and agreed scope of practice
- Attend daily ward / board rounds using the principles of Red to Green and SAFER Bundle to identify, plan, and assess for safe and timely discharge. Focus on achieving the Right Care at the Right Place and at the Right Time for patients.
- To adopt the principles of a Discharge to Assess Model (D2A). Align the discharge pathways including Pathway 1 (home or normal place of residence), Pathway 2 (bed based rehabilitation), and Pathway 3 (complex Assessment within a nursing care setting) to the patients assessed level of need.
- Take a 'Home First' approach, providing patients with support at home or intermediate care. Wherever possible, patients should also be supported to return to their home for assessment.
- Promote and work to the good practice guidelines of a D2A model, where going home is the default pathway (with alternative pathways for people who cannot go straight home
About us
Shropshire Community Health Trust is offering an exciting opportunity for motivated individuals to work within the Integrated Health and Social Care Discharge Team at the Shrewsbury and Telford Hospital Trust. The team is expanding and this is an ideal opportunity to be involved in the transformation of the service and work with the existing skilled team in the specialist field of Complex Discharge.
Details
Date posted
06 July 2023
Pay scheme
Agenda for change
Band
Band 5
Salary
£28,407 to £34,581 a year na
Contract
Permanent
Working pattern
Full-time, Part-time
Reference number
825-5391047-OPS
Job locations
Royal Shrewsbury and Telford NHS Site
Mytton Oak Road
Shrewsbury and Telford - Both sites
SY3 8XQ
Employer details
Employer name
Shropshire Community Health NHS Trust
Address
Royal Shrewsbury and Telford NHS Site
Mytton Oak Road
Shrewsbury and Telford - Both sites
SY3 8XQ
Employer's website
https://www.shropscommunityhealth.nhs.uk/ (Opens in a new tab)
Employer contact details
For questions about the job, contact:
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