The assessment process by the Integrated Discharge Team

Important Information before you leave – self checklist

There are a number of important questions that you need to be clear on before you leave hospital. If you cannot answer ‘yes’ to one of the questions below please ask a member of the clinical team on your ward to help you gain the answer.

1. Do you feel fully informed of who to contact if you feel unwell when you get home? 2. Are you aware of the reason you have been prescribed your medication? 3. Do you know of the potential side effects of your medication, and what to do in the event of one occurring? 4. Do you feel you have all the information you need before you leave hospital?

A member of the discharge team can be contacted if you need support. Any assessments our team carry out are not a test. It is simply finding out what help you might need at home to reduce any risks to your safety or independence.

The assessment process will start with discussions with you, your family/carers and the ward staff. This process of information gathering and discussions about your situation will enable the Integrated Discharge Team to work alongside you to: ■ identify your needs ■ give you information about services that could immediately support you to be discharged from hospital or support you in the longer term. Depending on how complex your needs are other specialist assessments may also be required. The referral process and time scales for assessments are outlined in the

Delayed Discharge Act 2003. The length of time required to complete the process can vary depending on how complex your needs are. The Integrated Discharge Team will do all they can to help people to live independently and safely. We work with the resources available to us, and therefore prioritise those people who are in greatest need of help. This guide tells you more about the assessments and eligibility criteria. It also tells you what will happen after you have an assessment. This may be relevant to you if you are an older person (65+), have a physical or sensory disability, have mental health problems, or have a learning disability. Please see the information in the following section about our assessment process.

Discharge from hospital

Once all ward MDT assessments are completed the team will discuss with you what help may be available, and decide with you how your care needs can best be met. We operate a process called Discharge to Assess for patients who might need support on arriving home from hospital. This involves arranging a support care package to ensure patient safety, with a full assessment being made in the home rather than in hospital. We also use Discharge to Assess, for patients who are medically fit to leave hospital, but require discharge to a community bed, other placement or require further discharge arrangements. Patients and relatives will be given notice of a discharge date as soon as it is provided to the ward.

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