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Wraparound Hospital to Home Service

We know that, for the most part, people are healthier and happier in their own homes and communities. We also know that third sector organisations embedded in those communities can help an individual return home from hospital in a safe and timely manner.

The need

The Wraparound Hospital to Home Service was been developed as part of a co-ordinated response to continuing pressures across health and social care within Dumfries and Galloway.

Our service targets and prioritises those at risk of delayed discharge, or increased stress and anxiety during a hospital stay.

The service

Our service helps to support and enhance the work taken to ensure a positive patient journey, by coordinating the support of third sector organisations. This includes enabling the patient to focus on their hospital stay by helping to mitigate the stress of home life, such as Carer support, support for pets, ensuring their home stays warm during winter months, and collecting and returning patient laundry.

We help to improve patient flow by communicating with the patient, Carer and hospital staff throughout a patient’s stay in hospital to ensure preparation for discharge.

The service’s key aims and objectives are based on accessing resources within an individual’s own community.

The service includes:

• Discharge support by liaising with local partner organisations in areas such as patient transport, befriending services, meal provision, pet support, shopping services, home adaptation, and home from hospital packages of support.
• Positive patient journey by working with the patient to understand stresses and anxieties during the hospital stay.
• Individual resilience by working to understand the patient’s current confidence levels in relation to their return to home, the concerns they may have, and the things that might contribute to readmission. We will then liaise with local partner organisations to put a ‘wraparound’ in place prior to discharge to help minimise the risk of readmission and increase the patient’s personal resilience on their return to home.