CAF Lessons Learnt
5. Hospital Discharge
Introduction
Hospital discharge was identified as a key theme in the CAF Programme because it is a transition point in an individual’s care pathway, where there can be problems with disjointed processes and information sharing.
Hospital discharge is the co-ordination of support for an individual to enable them to leave hospital, when they are ready to do so, to appropriate support in the community. This means that an individual has a better experience both in hospital and when they move back into the community and professionals are more able to support them in achieving this.
In the CAF Programme, demonstrator sites worked with hospital and community staff and service users and carers to revise current discharge processes and introduce use of electronic communications to make information sharing more efficient and effective.
Key Principles and Learning from the CAF Demonstrator Programme
Ø A highly technical solution does not necessarily need to be used, for example, benefits can be achieved by the use of secure email to share patient identifiable information more efficiently, legibly, securely and promptly than would be possible on paper or by fax
Ø Determine what systems are available in the different organisations to enable electronic communications and identify an appropriate solution based on those systems and within available resources
Ø Identify and review the current process to determine how future processes should operate
Ø Involve appropriate people in the process review, both staff and service users and carers, who will be affected by the changes
Ø The new processes could require staff, that were not involved in the original discharge process, to play a more active role – staff may require training
Ø It is possible to email sensitive information to non-secure recipients, such as voluntary sector organisations, patients and carers, using encryption capabilities available; this is currently being piloted by NHS London.
Ø It is beneficial to agree a common format for the electronic communication, e.g. referral form or delayed discharge notification
Examples from CAF Demonstrator Site Programme
The evidence documents shown below in bold italics can be found in the Hospital Discharge folder on the Common Assessment Framework for Adults Learning Network
Ø NHS London – secure email project. NHS London are promoting the use of secure email to support discharge notifications from hospital to social care through the implementation of a generic NHSmail email account within hospitals, and a corresponding generic GCSX/CJSM (Criminal Justice Secure Mail) email account within Social Care. Case studies available at: http://www.london.nhs.uk/lpfit/news-and-updates/case-studies/focus-on-secure-email-to-share-admission-and-discharge-notifications-across-hospitals-and-social-care-departments and pp.38-40 of http://www.rcplondon.ac.uk/resources/developing-standards-health-and-social-care-record.
Ø NHS London – Adapter Project. NHS London is also working with Quicksilva, to develop an adaptor that will enable standard discharge notification forms emailed from hospitals to be imported semi-automatically into CoreLogic and LiquidLogic social care information systems.
Ø Warwickshire – Trusted assessments - developing an assessment tool which can predict where a patient should be discharged to – reablement, intermediate care or community emergency response team. (See document: Warwickshire Common Assessment Tool Briefing).
Ø Southampton – Solent NHS Trust project. Looking at clinical correspondence and electronic discharge summaries, including improved hospital data submissions to the Hampshire Health Record.
Ø East Cheshire – hospital discharge project. Using a shared electronic form in the ShareCare assessment system, which provides a single referral to various services which are key to discharge (CHC, intermediate care, district nurses, community matrons and social services) and section 2 and 5 notifications to social services. Use of a single electronic form also enables the discharge co-ordinator and the services involved in arranging discharge to update information and track progress of the individual’s journey. (See documents: East Cheshire Hospital Discharge and Referral Specification and East Cheshire Evaluation – Hospital Discharge v1.1)
Ø Stockport – Although this area of work is outside the initial CAF project scope the site worked with DH and CfH to develop messaging for Delayed Discharges. The hospital trust have for some years used electronic discharge forms which the hospital social care team obtain via the Council’s N3 link. Adult Social Care are involved with health partners in a wider piece of work around delayed discharges and admissions
For further information see CAF Lessons Learnt
Ø Continuing HealthCare
Ø Options for information sharing
Useful links and other sources of information
Ø NHS Connecting for Health: Technology Reference data Update Distribution. (TRUD). The TRUD website provides specifications for electronic S2 and S5 discharge communications. These are held in the Message Implementation Manual (MIM) section under NHS DMSHSCI - https://www.uktcregistration.nss.cfh.nhs.uk/trud/
12.04.12. Find the complete version of the CAF lessons learnt at: http://www.networks.nhs.uk/nhs-networks/common-assessment-framework-for-adults-learning Page 1