What do the Assisted Discharge Team do?Based in the Emergency Department, and run by the Red Cross, the Assisted Discharge Service provides practical and emotional support to patients who have little or no friend and family support. We do this either to avoid an overnight admission or greatly reduce the risk of them re-attending. The service is aimed at patients who are medically fit, but due to not having much support at home, would benefit from an assisted discharge. We tend to promote ourselves as the ‘missing family member’ and advocate our support when the medical team are reluctant to send a patient home alone. The service offers support such as providing a safe discharge by transporting patient’s home in staff cars that are on site at the hospital. Once home, we can help with shopping, preparing meals and ensuring the home environment is safe and warm. Where a patient is not able to get in or out of a vehicle unassisted, they are referred to hospital transport where we can follow and provide resettlement support. We can also sign post patients to other agencies such as social services, benefits advice, home repairs and adaptations to meet individual needs. Where is it based and how long has it been operating at WAHT?The service is based in the Emergency Department (next to ED Matrons office). Although we prioritise patients who have been admitted through ED, we will also support patients from across all the wards within Weston General Hospital as long as the essential service criteria are met.It has been operating since December 2013 Which departments do you work closely with?We work with all clinical areas but more specifically with the Rapid Response In Reach Nurse; Home from Hospital Partnership; Carers Support; Mental Health Team; Discharge Coordinators; Occupational Therapists and Physiotherapists on site. We also liaise with the clinical hub of the Admission Prevention Team; Social workers and local care providers.What sort of support have you been able to provide?The main service elements are:
An example of the service we provide is best illustrated by the following case study: Mrs A, a 98 year old woman, was admitted to the emergency department following a fall at home. She was treated for a sprained ankle and deemed medically fit to be discharged. Nursing and medical staff, however, were concerned that she lived on her own and her family did not live locally. She was referred to the Red Cross Assisted Discharge team to ensure safe transportation and resettlement at home. The Red Cross team liaised with the physiotherapist who assessed her needs and issued two walking frames and a walking stick to be taken home with her. In discussion with Mrs A it became clear that she was nervous about going home and coping with the stairs. We assisted her into her home, placed one walking frame upstairs and one down and stayed until she familiarised herself with them to get about the house. We were able to prepare her a meal, take out the bins and, with her permission, remove loose mats and rugs (to prevent further falls) and stay until she felt confident to manage. In discussion with Mrs A, she agreed to be referred on for advice on re-housing to more sheltered accommodation as she felt she was starting to struggle with such a large house and beginning to feel a bit isolated. She also agreed that a ‘Carelink’ pendant would be a good idea. This case demonstrates the value of the assisted discharge service as often unmet needs are not obvious until you can see someone within their home environment. By supporting someone home the service can prevent readmission and enhance the overall experience of their period of hospitalisation.Pictured above are:-Back Row from L to RNia Hall – Service Co-ordinatorAdele Womersley – Service Co-ordinatorMel Cicone – Casual Service AssistantHolly Aimson – Service Assistant Front Row from L to RHelen Butler – Service Co-ordinatorMichelle Phillips – Service AssistantSam Harris - Service Assistant