Question

How to communicate in an optimal way with hospital services in case the user is admitted?

Problem description

When a patient is hospitalised our mobile teams doesn’t take direct contact with the user, this to avoid any form of divide for the patient (between hospital and mobile team).   The mobile teams are informed by the team of the hospital unit.

Impact - effect

The mobile team is not always informed when the user is discharged from hospital, and about the care plan during hospitalisation.  Users sometime feel they have been abandoned by the team.

To do

To do: once a week a team member visits the hospital service to be informed about what has been going on the last week in relation to the objectives of hospitalisation, and what kind of follow up has been planned (in collaboration with the existing network).  For instance: date discharge, weekend home trial…

Theme

Hospitalisation

Topic

Role of the mobile team when the user is admitted to hospital: inreach in residential units, early discharge

Reference -  contact

Aurore Vanoverskelds

Mobile team

2B

Project

Hainaut Occidental

Intership abroad - place

Birmingham (AOT Matthews Centre)

Date

February 2013