Discharge Coordinator

This is an exciting time to join one of the integral departments of the Acute and Urgent Care (AUC) Service Line at South West London & St George's as we are looking at new ways to improve the quality of the care as we promote effective patient flow.

The Discharge Coordination Team is a dynamic team that supports wards with:

• Promoting purposeful admissions by agreeing a plan on admission with an estimated discharge date
• Tackling barriers to discharge, preventing avoidable delayed discharge and transfer of care.
• Timely escalation of issues leading to increased length of stay to the service line, ICBs and Local Authorities.

Discharge Coordinators work in conjunction with internal and external partners in supporting proactive discharge planning and timely discharges in line with expected dates of discharge.

They focus efforts on behalf of individual patients at heightened risk of delayed transfer of care (DToC) from inpatient wards and provide accurate information/updates into the trusts daily discharge and pathway meetings.

Main duties of the job

This part-time role is an admin and clerical band 6 role and we are looking for a highly motivated Nurse, OT, social worker or experienced non-clinician to be part of a team that will help the service line to provide the best care for our patients by ensuring timely access to relevant services through pro-active assessment of needs and barriers.

The post holder will cover either Tolworth or Springfield Hospital wards. You could be based in any of those 2 sites. The post holder must be adept at prioritising the activities that will provide the most efficient, effective and safe discharge pathway and escalate any conditions that will prevent this from happening. They will be able to work closely alongside the ward consultant, ward manager and wider MDT.

They will be confident at building relationships, develop and foster relationships with staff across the acute and urgent care pathway and with partner agencies and will proactively manage these relationships so that staff can count on reliable and knowledgeable support and information about discharge processes. The successful post holder will have a good knowledge of community services and referral processes to ensure smooth discharges.

Job responsibilities

• Discharge Coordinators are responsible for coordinating and prioritising action from the MDT and partners to ensure that:
• Barriers to Discharge and Estimated Dates of Discharge forms are completed and updated in line with clinical reviews
• Intervening early to remove barriers to prevent patients becoming delayed transfers of care.
• Highlighting potential B list) DTOC patients to expedite discharge planning and prevent them becoming A list (reported) DTOCs.
• Updating Borough DTOC meetings on patients who are A and B list Delayed Transfers of care
• Verification of purpose of admission and expected length of stay
• Establishment of scope for discharge within 24 hours and work to expedite discharge: Invoking a rapid review by a Consultant (arranging temporary accommodation from budget to permit early home treatment (not exhaustive).
• Support carer engagement triggering Carers Assessments as required, and to work closely with carers and relatives in the interests of supporting timely discharges.
• Pre-empt and resolve arising barriers to discharge i.e. keys, other agency support to discharge.
• Promote conditions based discharge so that discharge takes place once agreed conditions are met.
• Ensure early liaison with Community Teams of pending discharges to HTT or direct to community teams.
• For detained patients to consider short periods of section 17 leave or the use of Supervised Community Treatment where appropriate in line with legislation and least restrictive principles.
• To develop effective relationships with local authorities, housing providers, tenancy support teams and benefit agencies specific to Boroughs
• Pre-empt, accelerate homelessness unit input / liaison.
• Introduce HTT involvement at the right point to commence facilitated early discharge by HTT.
• Investigate cases that are about to pass / have passed projected milestone dates recorded for passing key stages in the acute care pathway i.e. discharge review, discharge plan in place, discharge.

Person Specification

TRAINING & QUALIFICATIONS

Essential

• Current professional registration in relevant clinical subject/practice e.g. RMN, OT, Social Work, psychology or equivalent relevant experience in health, social care or voluntary sector
• Evidence of post qualification training/education
• Ongoing evidence of continuing professional development
• A commitment to completing full quality improvement development as outlined in the trust strategy

Desirable

• Training in providing supervision, mentorship or equivalent, or willingness to undertake training.
• Post Graduate degree (in relevant subject)
• To have completed or be working towards accredited courses which enable potential development
• Recognised training that supports clinical practice ( Psychosocial Intervention or DBT)

EXPERIENCE

Essential

• Demonstrable experience of working at Band 5 or equivalent for 2 years
• Experience of liaising with community agencies
• Experience of working with people who have experienced serious ongoing mental health problems
• Experience of working within a multidisciplinary team
• Experience of implementing the principles and practice of the Recovery approach

Desirable

• Experience of implementing changes in working practices
• Experience of using and supervising others in the use of psychosocial interventions
• Experience of using quality improvement methodologies
• Experience of implementing and monitoring standards of care, including clinical audit and governance

Knowledge & Skills

Essential

• Excellent communication skills, both verbal and written, and the ability to influence others in clinical decision making towards discharge
• Sound knowledge and skills in risk assessment
• Knowledge of safeguarding policies and procedures
• Clear understanding of the Mental Health Act, Care Act, Housing Act, Quality & Safety Governance, Clinical audit and relevant national policies
• An ability to develop, supervise, teach and manage junior staff
• Knowledge of recent initiatives across professional workforce
• Clear understanding of the process of supervision

Desirable

• Ability to contribute to, monitor and implement changes and improvements to services
• Familiarity with budget control and management
• Ability to monitor and control resources
• Knowledge of performance management procedures
• Specialised clinical skills, e.g. group work, anxiety/anger management, CBT, family work skills
• Appreciation of the ward/team manager's role and how to balance clinical and non-clinical responsibilities
• Knowledge of Recovery Model of care