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INTEGRATED DISCHARGE TEAM

INTEGRATED DISCHARGE TEAM. R ehabilitation & A ssessment D irectorate Acute Hospitals Division. Working in partnership with. Why an Integrated Team?. Provides a visible structure with clear aims and objectives across all agencies.

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INTEGRATED DISCHARGE TEAM

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  1. INTEGRATED DISCHARGE TEAM Rehabilitation & Assessment Directorate Acute Hospitals Division

  2. Working in partnership with

  3. Why an Integrated Team? • Provides a visible structure with clear aims and objectives across all agencies. • Brings together and builds on existing knowledge and expertise which promotes effective joint working. • Reduces barriers between organisations and agencies. • Promotes collective ownership of service and performance • Encourages and embraces innovation.

  4. Our aims? • Provide a whole systems approach to Discharge Management for all patient groups within Glasgow Acute Hospitals. • The Integrated structure ensures smooth , safe and seamless patient journeys, minimising gaps and delays and providing clarity of roles within the single team framework. • Improve and monitor performance across the raft of discharge activity (including the reduction in delayed discharge) and to set agreed joint performance targets within the team framework. • Streamline and strengthen links across the internal and external discharge network. • Provide a significant contribution to overall joint service planning and development within current agendas. • Further develop policy and practice for the whole range of discharge activities which will be fully inclusive to all patient groups.

  5. Our challenges ? • Reduce delayed discharges in line with current Scottish Executive targets. • Manage Acute admissions and patient flow in line with current Unscheduled Care Collaborative (UCC). • Engage with Community Health & Care Partnerships (CHP/CHCP’s) to deliver a consistent approach to admission & discharge service delivery. • Develop and monitor protocols for sharing of information and create a single framework of data collection, collation and analysis of discharge information (including delayed discharge) that can be shared with all partners with resultant action plans. • Develop patient, carer and staff information which assists and advises on all aspects of the discharge process. Monitor and meet best practice guidelines i.e. SIGN and NHS Quality Improvement Scotland. • Monitor and manage “Choice of accommodation on discharge from Hospital” process. • Working across different organisations

  6. Key to our success? • The Team (willing, enthusiastic, flexible, innovative). • Talking • Knowledge and understanding of partner organisations. • Promoting & evidence of best practice through audit & education • Blurring of roles that reduce duplication, particularly in assessment process. • Senior management support.

  7. Work in progress • Pan Glasgow approach within new structures. • Promoting effective multi-disciplinary working at ward level within acute settings. • Continual quality improvement of Discharge planning. • Moving nearer the front door! • Unscheduled Care Collaborative (UCC)

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