Discharge Planner smiling with a patient in bed

Discharge time is before 10:00am each day. We count on you and your family to help us follow this timeline. It is an important way to make hospital beds available to those patients who need them. We will talk to you early in your stay about when you are expected to be discharged. We suggest that you ask a family member or friend to accompany you home after discharge. Please make sure that you have all of your belongings, after care instructions, prescriptions and return appointments when you leave the hospital. If you have any questions or concerns about your medications, diet, activity or return appointments, ask a member of the healthcare team before you leave. If you need assistance with your discharge planning needs, please ask a member of your healthcare team to contact the service navigator.

Discharge planners work to provide the patient with proper care, whether it is in a community facility or a return to home with access to community support services. On admission, Discharge Planning plans for and coordinates the discharge or transfer of patients within the continuum of care.

Planning helps to facilitate a timely discharge, becoming a key coordination link for members of the care team.

Discharge Planners 

Discharge Planners at The Brant Community Healthcare System are multi-skilled, have the ability to work with people in crisis and an extensive knowledge of our community and the services available.

Discharge planners are involved in:

  • facilitating, negotiating and coordinating
  • patient advocate, liaison
  • pre-admit screening
  • admit but no bed screening
  • crisis intervention
  • bed utilization
  • transfers - repatriation, out of catchment area, palliative care, reactivation, rehab, medically complex, detox. centre, LTC, Retirement homes, group homes, Acquired Brain Injury
  • Quick Response Service
  • IV Outreach
  • air transports
  • community linkages - Community Care Access Centre (CCAC) etc.
  • conferencing with families/physicians/care teams
  • patient rounds
  • Public Guardian and Trustee
  • Financial Information - Involuntary Separation, copayments
  • chart reviews
  • rehab assessments
  • sit on care teams internally and externally

Discharge Planning Programs:

Quick Response Service

The goal of the QRS (Quick Response Service) is to prevent unnecessary admission to the hospital as well as to prevent visits to the Emergency Department. The population it serves is mostly seniors. QRS works in collaboration with community services such as CCAC and Long Term Care as well as other hospital services such as IV Therapy.

Outreach Program

The objective of the Outreach Program is to provide Long Term Care Residents the choice of receiving IV Therapy in their own environment (preventing hospital admission). Through the Outreach program more patients can receive treatment while in the comfort of their own 'home' environment. IV Therapy works with Discharge Planning to facilitate care for the patient in the patient's home, allowing for the prevention and reduction of hospital admission.

 
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