Discharge From the Hospital

This morning I came across an article in the New York Times, “Aftercare Tips for Patients Checking Out of the Hospital.” It struck a note with me since one of the most frustrating things I’ve witnessed in the last 15 years is the poor discharge planning that happens at some hospitals. Patients are being sent home with information that is so confusing they could never figure it out. Others shouldn’t be discharged but have no one to advocate for them and aren’t in a position to do so. In the effort of cost containment, patients are sent home when they and their caregiver-if they have one-are ill prepared to handle the situation.

The New York Times article recommends the following actions:

CHECK THE DRUG LIST Medication errors are a frequent cause of readmissions…Ask for an up-to-date medication list and then double-check the information with the hospital pharmacist. Make sure the patient knows when and how to take new pills.

You can print out a medication form from NextStepInCare.org, a Web site created by the nonprofit United Hospital Fund that offers free guides to help patients learn how to make the transition to a different care setting.

MAKE A DISCHARGE PLAN Most hospitals provide a discharge plan in writing, but it may be incomplete and difficult to decipher. Compile your own plan that can be a guide for the patient, the caregiver and other doctors.

The document should include a precise diagnosis, future appointments, a contact list and whom to call if new symptoms arise.
You can download the Boost program’s one-page Patient Pass form from the Project Boost Web site at hospitalmedicine.org. A similar form tailored to your situation — for example, for discharge from hospital to a home or to a nursing home — is available at NextStepInCare.org.

A patient ready to leave the hospital may not be ready to go home. Physical therapy, occupational therapy or wound care that would best be administered at a rehab facility or a nursing home may be needed first.
Talk to the doctor and the discharge planner about what location would be best for the patient. “A good transfer requires that care needs match the care setting,” Dr. Coleman said.

CONTACT THE PRIMARY DOCTOR Urge the discharge planner or the hospital doctor to contact the patient’s primary care physician and set up required future appointments. Ideally, the primary care doctor will take over where the surgeons and specialists left off.

“Research shows that the sooner patients see their P.C.P., the less likely they are to be readmitted,” said Dr. Barry M. Straube, chief medical officer of the federal Centers for Medicare and Medicaid Services. If the hospital staff is not making that connection, then pick up the telephone and make the call yourself.

I would add to this list Assess caregiver and patient’s ability to be at home/handle discharge. All too often this is overlooked. I’ve been in a situation where I begged the hospital not to discharge a patient because they were clearly unable to care for themselves and no one was available to do 24/7 care. I could write several posts on this type of situation.

The Time’s article mentions several websites that are excellent. Next Step in Care has an array of excellent materials to download, that will make discharge, as well as hospitalizations, much easier. These include:

Personal Health Record

Medication Management

Hospital to Home Discharge Guide

The Boost Project’s Patient Pass, is a good form to fill in and complete before discharge. It has all the information you’ll need in one sheet.

Many hospitals will provide a discharge summary of the hospital experience, including what procedures were done, diagnosis, who the treating physician(s) were etc. Make sure to keep these summaries in one place, preferably a Personal Health Notebook.