The Rotherham Foundation Trust: Working together across health and social care for effective discharge management

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The Rotherham FT worked with its local council to tackle high delayed discharge rates and ensure home was the default option for suitable patients leaving hospital. Previously, the trust had had delayed discharges rates of over 8 per cent and many patients suitable for discharge to home were not getting there immediately.

An integrated discharge team and a simple electronic referral process were a key part of the change, together with co-ordinated support for discharge home to ensure that patients had the right level of support.  

A therapy “trusted assessor” helps admission avoidance in accident and emergency and the acute medical unit. Delayed discharges are now mainly below 3.5 per cent and more patients are being discharged home – more than 80 per cent of over 65 non-elective admissions are now going straight home.

Patients are generally seen by the integrated discharge team on the same day and discharges are better planned.

Read a detailed case study about this project at HSJ Solutions


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