Background on Discharge service – RIVIAM Digital Care: Platform for care co-ordination

What is the Discharge service?

The Discharge service is designed to assist individuals who are about to be discharged from the hospital. It provides easier access to third-sector services and hospital teams can rely on this service to ensure smoother and faster discharge decisions.

How does it work?

Using a secure portal, discharge teams can complete an online referral form for the person. Completing just one online form can create multiple referrals.

These are directly processed by RIVIAM's Multi-Agency Referral Hub and sent to the various local authority services, health and social care organisations and multiple third-sector partners where the referrals are managed and coordinated.

Once the referral(s) are created, discharge teams can log into RIVIAM and access the Discharge dashboard. The Discharge dashboard allows ward staff to track the status of discharge-dependent support requested via the referral form and check if they are being provided for a person.

Discharge-dependent services are services that will be required to enable the person to be discharged from the hospital. Users can also use the dashboard to communicate online more easily with the partnering services delivering care.

Why is the service so useful?

For Discharge teams:
The Discharge Service helps Discharge teams to understand the situation for each person, enabling informed discharge decisions.

By streamlining the process digitally, hospital beds are freed up faster, patient flow improves and ensures the person has the necessary care and support at home, preventing re-admission.

The Discharge Service means users can digitally:

• Complete one online form that can create multiple referrals sent to a variety of partnering Local Authority services, health and social care providers and third-sector organisations on RIVIAM.

• Identify and issue referrals for people who require discharge-dependent services.

• Quickly identify people where an expected discharge date has elapsed and view the status of referral/s.

• View the progress of a referral being managed by a partnering organisation.

• View a timeline of activities being managed by a partnering organisation.

• Communicate with partnering organisations.

For partnering organisations:

For Local Authorities, health and social care providers and third-sector organisations, the Discharge service provides a coordinated, efficient way of supporting individuals who are clinically ready to be discharged from the hospital but require support at home and access to community services.

Using RIVIAM’s Multi-agency Referral Hub, partnering organisations will be able to connect with the discharge teams, to see patients requiring their services and who are currently in hospital.

By knowing when a patient is expected to be discharged, these organizations can prepare their services accordingly. This ensures a smooth transition for the patient to return home.

Partnering organisations will have:

• Their own view of the Discharge dashboard to monitor and manage the progress of a referral via RIVIAM Workflow.

• Access a single view of a person's referrals, and manage timelines to progress the referral through to completion. This helps teams to efficiently and effectively coordinate care.

• RIVIAM will automatically update the status of a referral which the discharge teams will be able to monitor and view progress.

Third-sector organisations can access RIVIAM as part of a centralised Multi-agency Referral Hub.