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2.2.35 Hospital Pre-discharge Arrangements

Contents

  1. Child Presented at an Urgent Setting
  2. Child Admitted to Hospital


1. Child Presented at an Urgent Setting

Where child protection concerns are raised, has been or is suspected by any attending professional about a child presented at an A&E department or minor Injuries Unit (MIU), Specialist Children’s Services (Kent)/Children’s Social Care Services (Medway) must be informed immediately by phone and an inter-agency referral form sent within 24 hours.

The child should not be sent home without a Strategy Discussion being held and all decisions agreed and recorded. This should apply during out of hours given the risk associated with discharging children at night or over the weekend.


2. Child Admitted to Hospital

Scope

A hospital pre-discharge meeting must be held whenever a professional or agency has raised child protection concerns about a child admitted to hospital, and this includes:

  • Concerns relating to incidents or circumstances that may have arisen either prior to or during the hospital stay;
  • Circumstances in which differing opinions are held between professionals about the origin of an injury or the risks to the child.

Once a child protection concern is raised at the hospital, Specialist Children’s Services (Kent)/Children’s Social Care Services (Medway) must be informed immediately by phone and an inter-agency referral form e-mailed using secure accounts or  faxed within 24 hours and Strategy Discussion/s held prior to a pre-discharge meeting.

The pre-discharge meeting can be organised by the consultant in charge of the child or another suitable delegated health or Social Care professional. Other relevant agencies i.e. Specialist Children’s Services (Kent)/Children’s Social Care Services (Medway), Police should be included as required.

The pre-discharge planning meeting must be arranged sufficiently early to ensure that a pre-discharge plan is in place before the child becomes medically fit for discharge.

Purpose of Meeting

The purpose of the pre-discharge meeting is to:

  • Consider medical and social reports about the cause of concern;
  • Consider the social work / multi-agency assessment/s of the risks to and the needs of the child, including ‘home safety’ informed (wherever practicable) by a home visit by a social worker the results of which are shared at the meeting;
  • Consider needs / risks in relation to other children in the family;
  • Clarify on-going medical care;
  • Identify support needed for carers once discharged;
  • Formulate a multi-agency plan on discharge from hospital that address’s the risks / concerns raised in respect of the child;
  • Agree timescale for discharge, once the child is medically fit.

The pre-discharge plan should be circulated to the relevant CCG professionals i.e. GP, health visitor, school health advisor and contain clear information on future follow-up arrangements for the child/ren.

Chairing

The social work team leader / practice supervisor or consultant / designated deputy should chair these meeting and may give guidance on which health professionals need attend.

Possible Attendance

The potential members of a pre-discharge planning meeting are:

  • Consultant (or designated deputy);
  • Social work team manager / practice supervisor / senior practitioner;
  • Social worker/s;
  • Police officer Public Protection Unit;
  • Ward staff;
  • Paediatric liaison health visitor;
  • Health visitor and midwife (if child is new born);
  • School nurse;
  • GP;
  • Designated / named nurse;
  • Any other professional with information to assist decision making.

Though parent/s should not normally attend the pre-discharge meeting, if part of a Strategy Discussion, they will need to be informed of any decisions made at it.

Quoracy

To be quorate the meeting must be attended by representatives from the primary care provider, Local Authority Children’s Services, Police and hospital medical and nursing staff.

Records of Meeting

A minute taker must be agreed by those present at the pre-discharge planning meeting and s/he should make a brief record of the discussion and of the ‘agreed plan’. This record must be copied and given to all members at the end of the meeting.

It is the responsibility of the agencies present to ensure appropriate onward communications; e.g. the health agency must share its record with the GP, health visitor, school health advisor, named nurse and, (if the child is looked after) notify the designated nurse for Children in Care(Kent) / Looked after Children (Medway).

The chair / designated deputy must place a handwritten copy of the decisions agreed at a pre-discharge planning meeting on the child’s medical notes directly after the meeting and this must be left at the hospital.

If an incident number has been raised with the Police, this should also be recorded.

The social worker should ensure the decisions of the meeting are recorded on the social care database immediately and consider raising an out of hours alert if the database recording is not immediately possible.

Timescales for Pre-discharge Planning Meetings

As soon as medical staff are able to predict the child’s fitness for discharge, they should convene the pre-discharge meeting and thus provide an opportunity for professionals to undertake checks, read files and attend the meeting.

Because an assessment of risk must be concluded before the child/ren is / are ready for discharge, a pre-discharge planning meeting will normally be convened within 24 hours of it being called. This narrow time-frame requires a high level of flexibility and co-operation between professionals.

Consultation with Designated / Named Child Protection Doctor / Nurse

If it is unclear whether an injury has a non-accidental cause, the consultant in charge of the child’s care should seek a second opinion either from the designated / named child protection doctor / nurse or from a specialist consultant.

If achievable the second opinion should be available to the pre-discharge planning meeting.

Other agencies particularly Local Authority Children’s Services need to be made aware that a second opinion has been requested and the consultant in charge of the child’s care should advise on the anticipated timescale.

Even if there is no clear diagnosis of non accidental injury in the medical report, an assessment of need and risk should be made.

Parental Support

The pre-discharge planning meeting should clarify how the parents will be supported and who will undertake this role.

End