Our hospital team – the Integrated Discharge Team

Problems or queries

If you have queries or are experiencing difficulties relating to your discharge you can either contact your discharge coordinator from the ward or the discharge team office, or speak to the nurse caring for you on the ward. They can also give further information and contact details that you may find helpful. Our hospital team – the Integrated Discharge Team

Our team based in the hospital is made up of health and social care workers which enables a holistic approach to safe, effective and timely patient discharge.

In this team there are therapy representatives, social workers, assessment and enablement workers, intermediate care nurses, complex discharge nurses and discharge coordinators. They help the ward team to ensure patients are discharged safely to the appropriate destination.

How am I referred to the Integrated Discharge Team?

Planning for discharge normally begins at the point, or even before, you are admitted to hospital. The discharge process is coordinated by a member of the nursing team on the ward. Following an initial assessment by nursing and medical staff, the discharge coordinator will meet with you to discuss your discharge plan if you have needs that require assessment. You can also give your consent to your carer who can ask for you to be referred to the discharge team. If you have any queries when you are staying in hospital or if you would like any general advice, please ask your nurse to contact the team. A patient has to lack capacity for the power of attorney for someone to be able act on behalf of the patient Lasting Power of Attorney (LPA): If you are reading this on behalf of a relative or friend who is a patient with us, and there is a ‘Lasting Power of Attorney’ registered with the Office of the Public Guardian in place for that patient, please ensure that ward staff receive a copy of the document, or are provided with evidence of the LPA for our patient notes. It is important that we have a certified copy of any existing LPA for ‘Person’s Health & Welfare’. Please note that an LPA relating to property and affairs does not give anyone power to make decisions on behalf of the patient in regard to their treatment. However in the event that the patient’s circumstances have changed and they need to be considered for a placement such as a care home or nursing home, if you hold their LPA for property and affairs please confirm this to the nursing team. They will, if necessary, ensure that a member of the Integrated discharge team contact you to review the ongoing needs of the patient. Please also note that we cannot act upon any LPA unless we have certified evidence that it exists. We cannot act upon a verbal notification of its existence. Once we receive the copy or other evidence we will ensure that a care plan is put in place agreed with the person(s) holding the LPA. Please also remember that an LPA is not the same as an ‘advanced directive’ unless this has been included in the LPA.