HOSPITAL DISCHARGE

A straightforward pathway from hospital to appropriate nursing care at home.

Support a safer transition from hospital to community nursing with clear referral pathways, clinical follow-up and communication with the veteran’s treating team.

Hospital to home Clear clinical handover and community nursing follow-up
DISCHARGE SUPPORT

What we do for discharge teams

01

Accept the referral and confirm receipt within 24 hours.

02

Conduct a home assessment.

03

Deliver nursing care in the veteran’s home.

04

Communicate with both the hospital team and the veteran’s GP.

05

Recognise and escalate deterioration.

06

Support the transition from acute care to community nursing.

CLINICAL SCOPE

Clinical scope for post-discharge care

Wound care

Post-surgical wounds, complex dressings and VAC therapy.

Medication

Reconciliation, administration support and monitoring.

Post-surgical recovery

Monitoring, wound assessment and complication recognition.

Palliative

Symptom management, family support and palliative team coordination.

!
Discharge referral validity

DVA Community Nursing referrals following hospital discharge are valid for 6 weeks from the discharge date.

REFERRAL INFORMATION

What to include in a discharge referral

✓

Veteran’s name, DVA file number and card type.

✓

Date of discharge.

✓

Clinical summary and reason for referral.

✓

Current medications and changes during admission.

✓

Wound status and dressing regimen, where applicable.

✓

Follow-up arrangements already in place.

✓

Clinical concerns or escalation triggers.

✓

Family or carer contact and discharge planner contact details.

PRIVACY

Privacy Collection Notice

i

One Vision Community Nursing collects referral information for assessing and delivering DVA Community Nursing services.

Please only submit information necessary for the referral and ensure appropriate consent has been obtained.

Read our Privacy Policy →
BEFORE REFERRING

DVA card type

Please confirm the veteran’s DVA card type before continuing to the referral form.

HOSPITAL DISCHARGE REFERRAL

Referral form

Complete the referral form below with the relevant veteran, discharge and clinical information.

Loading referral form…
NEED TO DISCUSS A DISCHARGE REFERRAL?

Speak with our team

If you need to discuss suitability or discharge planning before submitting a referral, contact One Vision Community Nursing.

Name
DD/MM/YYYY
DVA Card Type
Recent Hospital Discharge
Referral Urgenc
Consent
I have read and understood the Privacy Policy.