Discharge Planning
A series of discharge planning meetings are needed to assess the child/young person's needs. The meetings should be child & family centred. The aim should be to have the first discharge meeting as soon as possible to plan for the child's discharge from hospital.
A child's best interests are served by being in hospital for the briefest possible time necessary for safe and effective treatment. However, the move from hospital to home is a time of increased risk and stress for child and family. 'Discharge planning' is the process of identifying the ongoing health and social care needs of the child and family, making plans that ensure the safety and continuity of care, preparing the family, and coordinating the contribution from different professionals and agencies. Involving primary care and informing the family GP at an early stage will help the planning process.
The discharge planning should follow the Care Coordination (CCNUK) model with an identified Lead Professional / Key Worker and action points with time scales identified. The construction of the Care Coordination group will be dependant on the child's underlying problems but should include all those who have a relevant role in the child's case and should include colleagues for social work and education and relevant voluntary organisations.
It is important to look at the age of the child to organise suitable discharge planning. Support in educational and social placements including transport should be linked with Individualised Planning and Section 23 assessments. Sometimes housing issues will need to be addressed. Transition age discharge planning focuses on how the needs of the young person will be met in adult services.
Useful web sites:
Useful documents:
- Discharge pathway for children with complex needs (July 2010, Lothian)
- Complex Discharge Record (July 2010, Lothian)
- Using the complex discharge record (July 2010, Lothian)
- The immediate discharge document (Jan 2003, Scottish Intercollegiate Guidelines Network)
- Discharge Planning list (Lanarkshire)
- Care Pathway for a child being discharged home on mechanical ventilation (Dec 2005, WellChild)
- From hospital to home (Barnardo's, 2005)
- National Service Framework for Children, Young People and Maternity Services, Long term ventilation (Barnardo's, 2005)
- Long term ventilation pathway checklist (Feb 2007, Leeds)
- Care Pathway of Discharge (Feb 2007, Leeds)
- Guidelines on the discharge from hospital of children and young people with high support needs (Council for Disabled Children, England, 2010
- RHSC Discharge Planning Process Consultation paper
- Integrated Care Pathway, Transition from Acute Hospital to Community Services (July 2009, Northern Island)
- Discharge Planning Checklist (Sept 2010, Lothian)
- Discharge Planning Pathway for Children with Palliative Care Needs (August 2010, Greater Glasgow & Clyde)