Managing patients at risk of hospital admission

Tri Locality Care (TLC) Ltd has launched a Project, commissioned by West Hampshire CCG, to identify vulnerable patients and those at high risk of hospital admission and manage this caseload both proactively and reactively to maintain care outside of hospital, as appropriate. There will be strong links and close working arrangements in place with the community care team, the integrated care team, social and voluntary sector organisations as well as secondary care when needed. The team have been working with University Hospital Southampton FT and the Community Emergency Therapy team.

The service was launched in August 2018 so is at a very early stage. The aim for the Emergency Department Therapy team is to identify 1-2 patients that would benefit to be signposted to the service non urgently to reduce the ongoing need for admission. Services provided include bereavement support and accessing support.