Detailed job description and main responsibilities

MAIN DUTIES AND RESPONSIBILITIES OF THE POST: 
• To support and co-ordinate discharges through the D2A process by multi-agency coordination and working with patients and families to discharge in a timely manner.
Responsibility for a cohort of patients along with a discharge co-ordinator and 
responsibility for co-ordinating their timely discharges.
• Managing all data and recording of discharge information for a cohort of patients.
• Offer advice and support to patients and relatives on funding, placements, and care 
packages. Provide guidance on services to aid in discharge, such as Action for Carers 
and Home Safe Plus.
• With the Discharge Co-ordinator and in their absence, Co-ordinate the discharge of 
patients engaging the IDB and MDT in any concerns or provision of needs.
• To work autonomously within their scope in, providing a comprehensive discharge 
advice and information to ward staff, patients and relatives.
• To identify critical delays in the entire diagnostic, treatment and care processes and 
be proactive in generating solutions that could be out of the norm that will speed up 
the process eg: escalating to departments and Manager, thinking of services that can 
stop gap or be purchased in a different manner and bring to the attention of The Team 
Leader for consideration.
• Cover ward areas as directed by Team Leads or Managers in the absence of other 
Discharge Team members.
• To attend board rounds daily and facilitate meetings with staff around discharge.
• To follow the Trust’s Discharge Policy and in liaison with Community, Social Services 
and other healthcare colleagues, to facilitate timely, appropriate and safe discharge 
of patients to the community.
• Ensure patient confidentiality is maintained by keeping all written and electronic 
documentation complete, accurate, and up-to-date. Handle and share sensitive 
information strictly on a need-to-know basis. Report any safeguarding concerns and 
complete Datix incident reports as necessary.
• To support multi-disciplinary meetings in response to complex discharges with the 
goal to resolve any outstanding blocks to a successful discharge.
• Assist in identifying patients who meet the criteria for Continuing Health Care, 
particularly those with high-intensity health needs. Support referrals by helping wards 
complete Fast Tracks and navigate the referral process.
• Identify when there is need to resolve disputes or disagreements around discharge 
planning or leaving hospital to come to a resolution to avoid delayed discharge, being 
autonomous in this, escalating any issues unable to resolve to the Complex Discharge
Team Managers/ Lead.
• Support on any administration roles and rehab roles where required.
• To have a knowledge and understanding of Power of Attorney and Court of Protection 
and how these impacts on patients discharge plans. (Power of Receivership), Mental 
Capacity 
 Act, Deprivation of Liberty and other legal frameworks.
Information and Reporting 
• Record accurate data entry into IT systems using the correct response times on IP 
PTL and Cerner
• To participate in audit of the effectiveness of discharge planning within the acute Trust 
and to collect and analyse relevant data as required.
• To participate on MFFD calls and the tracking of patients.
Staff Training 
• Facilitate and support Complex Discharge Training and processes for all ward staff, 
ensuring they are kept informed of any updates and changes.
• Arrange shadowing opportunities for new staff and Ward Flow Navigators with the 
Complex Discharge Team.
• Educate and assist ward staff in completing Discharge to Assess (D2A) referrals, 
including exporting data from Cerner and submitting it to the D2A Duty Triage inbox 
for review.
• Promote adherence to discharge policies and ensure ward staff complete safe 
discharge checklists on Cerner, with the go-live date to be confirmed.
Service Delivery:
• Fulfill defined responsibilities across a seven-day period to address the needs of the 
service, ensuring smooth patient flow and supporting discharges to Community 
Rehabilitation and Block Contract Beds.
• To support the Complex Discharge Team Lead and Divisional Heads of Nursing in 
maintaining safe discharges.
• Keep accurate records for audit purposes and liaise to review feedback by service users to evaluate the effectiveness of the service.