Hospital discharge:

Supporting families making care choices

Our service is proven to reduce delays to hospital discharge by providing high-quality support for families who need to make care choices.

Many of the patients who remain in hospital for a long time after being medically optimised for discharge do so because a care choice must take place. Often, discharge is delayed because the patient’s family struggles to find and choose a care home. There are multiple barriers: there may be difficulty finding a care home that has capacity, or one that can meet complex needs; family members can feel overwhelmed or disagree. All affect the process of decision-making and thereby delay hospital discharge.

Our service addresses the multiple causes of choice delays to hospital discharge.

This is how it works:

  • Our team receives referrals for patients medically optimised for discharge who need to move from hospital to 24-hour care
  • Our team contacts patient’s next of kin on the same day as the referral
  • Our team provides an evening and weekend working service which means no time is lost
  • By providing families with a shortlist of suitable care homes with capacity who meet their needs, we support them to focus on relevant providers
  • Care home is chosen within two days of referral
  • We work closely with care home providers to ensure they carry out their own hospital-based assessment as promptly as possible
  • Transfer from hospital to care home takes place within a total of five days of referral

Quality of reporting

By focusing on every aspect of the process, quickly addressing any delays and constantly seeking improvements, we achieve huge improvements in speed of discharge. The quality of our reporting is widely valued; enabling us to achieve optimal process management and providing key business intelligence to commissioners.Evaluation of our service is overwhelmingly positive: families value the tailored support provided at a very difficult time. Consistently, more than 95 per cent of service users say our support was ‘excellent’ or ‘good’.

We often work with people funding their own care; recognised as a group in need of support at greater risk of choice delays. We often work with families of individuals with Fast Track end-of-life funding, where sensitivity and speed of process are both essential. Our hospital discharge family support service can be commissioned for all patients, or for specific funder types.

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