Senior Discharge Navigator (Nurse or Therapist)

Job overview

We are looking for an exceptional individual to join the Transfer of Care Team at the Royal London Hospital as a Senior Discharge Navigator and Lead Screener. The Transfer of Care Team is a joint health and social care service aimed at facilitating discharges from acute settings, based on the home first principle.  The team prevents avoidable delays in patient discharges through coordination and planning in accordance with current government discharge guidelines. You will problem-solve to overcome challenges and work with the ward multidisciplinary teams, senior management and external agencies as well as advocating on behalf of your patients.

You will be a screener of referrals into the service, with a large part of your daily duties screening these referrals to ensure they are appropriate and are directed to the right service dependent on patient need. While being ward based, this is largely not a patient facing role, with clinical skills used in the screening and identification of patient needs in order to direct to the correct community services to support on discharge.

In addition you will undertake discharge co-ordination of patients from acute hospital settings to ensure their social, health and equipment needs are met on discharge.

Main duties of the job

• To lead the discharge assessment and planning of patients with complex discharge needs, from advanced planning prior to discharge to the point of onward transfer, with a proactive case management approach drawing on post holders specialist nursing, occupational therapy, physiotherapy or discharge skills dependent on specialist professional background..

• To work collaboratively, as part of the Transfer of Care Hub team and with ward based multi-disciplinary teams and community health and social care partners. To lead the co-ordination and management of specialist discharge plans that reflect the ongoing complex care needs of patients, and respect their wishes.
• To lead on co-ordinating early complex discharges so patients leave hospital within 24 hrs of being declared Medically optimized and ready for discharge in order to minimise discharge delays, improve inpatient flow and reduce the possibility of clinical deconditioning .
• To proactivley identify and escalate any potential delays in discharge and lead on complex problem solving/case review meetings requiring analysis and interpretation of a number of complex factors and options as required.
• To screen referrals, identifying the appropropriate pathway for discharge for community health and social care services based on assessment, analysis and reasoning through an evidence based approach.

Detailed job description and main responsibilities

The full job description provides an overview of the key tasks and responsibilities of the role, and the person specification outlines the qualifications, skills, experience, and knowledge required. For both documents, please view the attachment/s below.