September 16th, 2010 at 2:14 am
Bookmark and Share

Be Sure You Are Discharged Safely

by Sue Lanza

You may know a recently hospitalized neighbor or a friend who we would call a “frequent flyer”. Yes, these are the folks with chronic illnesses who finish one hospital stay and before thirty days have elapsed, they are back in the hospital again.

What goes wrong here? As an Administrator of a hospital-based Transitional Care Unit, a unique type of sub-acute unit that handles patients in the eight days before they go home, I can tell you that proper discharge planning has much to do with identifying potential issues and making the discharge “stick”.

You see, our unit was designed to get people out of acute care quicker while providing the opportunity to focus on the specifics of discharge planning. Since our patients are only with us eight days or less, discharge planning begins before they transfer over from the hospital.

Unfortunately many people who are discharged from a hospital setting don’t get the proper coordination during the critical discharge. It appears that more staff time is usually spent on the admissions process rather than the discharge. Sometimes a physician comes into the hospital and makes an abrupt decision to send someone home. The nurses and discharge planners scramble around to give the discharging patient some complicated information about the next few days or week at home. Because of the rush to turn the bed over and the patient’s lack of focus on this critical data, some things fall through the cracks, even when the instructions are put in writing.

Discharge info can be overlooked or misinterpreted which can lead to complications and re-hospitalization. In fact one recent study in the New England Journal of Medicine suggested that returns to the hospital for Medicare recipients may be one in every five. Besides the danger of recurring illness, the costs are in the billions for the frequent flyers.

So where do things typically go wrong during discharge? The discharge instructions should be in writing and it would certainly help to have another support person with the patient to listen to the instructions. Remember that the patient has just been through a hospital stay so the mind is not at it’s best in retaining detailed information. The discharge guidelines will usually include information about medications to take and when, any changes or symptoms to watch for and dates for any return physician visits or outpatient care.

In addition to having another person listen in to the instructions, it would help to have someone take notes on the form itself. For instance, the discharge sheet may say, “take med twice daily”. It would help to know times or any other details that will be quickly forgotten if not noted. Another suggestion that people often overlook as they go home is to get back in touch with their primary physician. The regular doctor may not have been the one who treated the patient in the hospital so looping them back in may help keep you or a loved one from being a familiar face in the emergency room.

Posted in Caregiving, Health, Medicare | No Comments »
Tags: , ,

Leave a Reply