Rhian Green, Meilys Smith and Lisa Goodier
Cyngor Gwynedd
Project Background:
Good information sharing between the Health Board and Local Authorities is needed to support effective and efficient hospital discharge.
To help address the information gap and support the aim of improved discharge, Council and Health Board staff in Gwynedd and Môn now have access to a list that merges and presents patient data extracted from the respective systems.
The list contains core patient data, hospital setting, Community Resource Team area, social worker, home care provider, and ward/community contact details.
Project Aims:
- Work with Social Services teams and Ysbyty Gwynedd to improve discharge procedures, using the list as a key tool.
- Have earlier conversations around discharge and the support needed.
- Identify over-prescription of statutory care and divert to 3rd sector support if needed.
A snapshot of the list, filtered to show inpatients from the Bethesda CRT area in all wards in Ysbyty Gwynedd. A ‘hover over’ function provides further details e.g. ward phone number, NHS number, DOB, admission method and the Predicted Discharge Date.
Project Outcomes:
Wales-wide interest in the list and its possible applications.
Support of senior leadership (HB & LA) to expand use of list.
Support of senior leadership (HB & LA) to continue exploring use of non-statutory support in discharge, using list as key tool.
Project Impact:
Social work teams are more proactive in their approach to hospital discharge.
Social work teams able to better plan discharge and coordinate with care providers.
Improved confidence within Social Work teams around discharge.
Easier for Social Work teams to contact wards to plan care and discharge.
