Digitised Hospital Discharges

One key development in Nottinghamshire is the digitisation of the entire social care hospital discharge referral process across all the main hospital trusts in the county. The development has transformed how around 10,000 hospital discharges a year are managed for patients, front line staff and senior managers across organisations.  

The digital referrals were shown to remove “unseen delay”. This was where a nurse may complete the required documentation then send through and the admin would process and update to systems sent to social care. At times with no admin staff in this meant a delay to reach the social worker. 

Although Social Workers started work as soon as they were alerted to a patient needing support by email or paper, the digitised referrals make sure this happens in a much more timely manner. It also prevents the other main issues that caused problems for them on a daily basis.

These issues included: being unaware of updates, wasting time going to a ward only to find a patient had been moved, or prioritising discharges only to find the patient had deteriorated. They often weren’t aware if a patient had died and would then have very upsetting and awkward conversations with family members. 

The digital referral is now linked directly to the hospital systems, updates on patient ward location, medically fit status and predicted discharge date. If a patient passes away in hospital, the social care staff get notified of this change instantly. They are looking at the same data that their health colleagues see.

Case study - closure of Oakham Ward, Mansfield Community Hospital (MCH)

  • The ward had to be closed quickly due to a health and safety issue. All patients were moved immediately to other wards across the Trust (Mansfield, Newark and King’s Mill Hospitals)
  • Multiple social care patients were on the ward at the time where workers were involved in supporting their discharges home.
  • As soon as new ward location was entered into the hospital system for each patient, this was known to the involved workers in social care
  • Having this update to ‘change in circumstances’ reduced the need for our service advisor spending a lot of time trying to get the ward information for all these patients had moved to.
  • It also ensured the ward staff did not duplicate referrals, as their system showed that social care were already involved. Previous use of paper-based forms often led to duplicate referrals sent by nurses.

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