Exciting changes introduced to support seamless patient discharges from hospital

2 November 2023 Exciting changes introduced to support seamless patient discharges from hospital West Coast residents who find themselves in hospital are expected to benefit from recently introduced changes aimed at supporting seamless patient discharges from hospital.

As part of winter pressures initiatives Te Whatu Ora West Coast’s Complex Clinical Care Network (CCCN) team trialled a CCCN Clinical Assessor position as a ward-based liaison focused on supporting holistic, patient centred, restorative discharge planning from Te Nīkau Hospital’s general ward. The role utilises a range of supports and services to facilitate a seamless return to the community and aims to enhance equity and positive outcomes for tāngata and their whānau.

Given the rural nature of the West Coast this can at times be challenging.

CCCN Manager Sue Jermyn says: “due to the success of this initiative the position has become permanent, and we are thrilled to announce the appointment of Deb Bennington into the role.

Deb is an Enrolled Nurse who brings with her a wealth of experience in the Needs Assessment Service and the wider Te Tai o Poutini Health service. She has a real passion and commitment to the West Coast and has shown dedication to the development of the role to ensure the greatest benefit to the community.”

Clinical Assessor Deb Bennington says: “the role is really important as it focuses on ensuring safe patient discharges via a single point of contact who interacts with patients and their whānau.

This also includes liaising with Aged Residential Care facilities if this is level of care is required.”

“Patients are only discharged when they are stable enough to go home, and any services needed to support them in their own homes such as physiotherapy/occupational therapy or support worker assistance are in place. Take for example someone who has just had a hip replacement, we will look to provide them with a package of care to support them until they regain their independence. As each person is different, we tailor the care to meet individual needs so a package may include, help with completing exercises, goal setting to return to previous social activities, help with showering/dressing and taking medication. On the day of discharge, we also check that scripts for any medications have been filled and transport home has been arranged.”

Post-discharge support is provided by CCCN which is a needs assessment service made up of different healthcare professionals who have traditionally worked in the community with primary and community care providers to help people with complex needs live independently for longer in their own homes.

“Coming into hospital for surgery or being admitted due to a medical event can be really stressful, so it’s important to me that we support our patients well by providing patient centred care.

Ultimately, we want to keep people out of hospital and the best way to do this is to have all the right services in place when they are heading home. The reward for me is knowing that through innovation we can make a positive difference every day to how West Coast residents experience health care,” says Deb. Photo: Clinical Assessor Deb Bennington outside Te Nīkau Hospital’s general ward. * This article was published in Issue #44, Tū Mata Kōkiri (All Staff Pānui) on 2 Whiringa-ā-rangi (2 November 2023). Past issues of Tū Mata Kōkiri are available on Te Whatu Ora Health New Zealand’s website – HERE.