Useful documentation 

Home First – Working together to get patients home

Once people no longer need hospital care, being at home or in a community setting (such as a care home) is the best place for them to continue recovery. Here are some helpful reminders for our ward staff to help us to get our patients discharged safely in the most efficient way:

  • Think Home First, why not home, why not today?
  • Does the patient have a Right to Reside? Click here to see the Right to Reside codes.
  • If the patient doesn’t have a Right to Reside they should be flagged as Medically Optimised on their Red2Green record on Meditech.
  • Ward staff MUST inform the Pharmacy Team of discharge to ensure medication screening prior to patient transfer / discharge. Over the weekend, ward staff on the South Tyneside side will need to notify the Pharmacy team via bleep 471.
  • Have a conversation with the patient and, where appropriate, their relative regarding their discharge plan and pathway and provide a copy of the relevant Hospital Discharge Leaflet.
  • Identify the correct pathway on Meditech; attaching supporting documentation, where required.
  • If the patient is being discharged to a bed based service or a Care Home they MUST have a COVID swab within 48 hours of discharge. Please check the status of swabbing before referring and seen advice from the IDT.
  • The IDT Team will contact the ward for information to support the referral. This information needs to accurately reflect the patient’s needs. Delay in gaining information may cause a delay in discharge.
  • Use the Discharge Lounge to help free up beds
    • Transfer from ward to Discharge Lounge promptly for Pathway 0 patients within 1 hour of the decision
    • Transfer from ward to Discharge Lounge within 2 hours of the decision for all other pathways.
  • Before contacting the Discharge Lounge; ensure the patient has had their medication checked and discharge documentation is ready. Please also ensure that accurate mobility handover is provided.

Patients requiring IV antibiotics 

The requirement for IV antibiotics is one of the reasons why a patient may need to remain in hospital. The Sunderland Recovery at Home Team and the South Tyneside Acute Intermediate Care Team are community teams that provide interventions to support early discharge. Administration of IV antibiotics is one of the treatments that can be continued on discharge with the support of a management plan.

Do you have a patient whose main reason for staying in hospital is to receive IV antibiotic treatment? Could the patient return home and continue their treatment in their own home?

  • To discuss a discharge / referral; for Sunderland contact the Recovery at Home Team on 0191 561 6666 or; for South Tyneside contact the Acute Intermediate Care Team on 07909975364. 

Street Homeless Discharges

Please ensure the following when discharging a patient as street homeless:

  • Patient has capacity
  • Referral has been made to LHA
  • If the patient has any ongoing medical needs eg dressing changes / medication that appropriate arrangements are in place prior to discharge.
Return to Our Services