The patient's physician may discharge the patient from a particular service within the hospital to another service (for example, discharge from the ICU to the inpatient medical unit) or discharge the patient from the hospital to any one of a variety of settings.
The patient may initiate discharge from the hospital if he or she chooses
to seek services from another medical provider or wishes to leave against
medical advice.
In
most cases the physician initiates discharge for one of the following
reasons: The
patient does not meet the medical criteria for continued stay in
an acute hospital
setting. The patient may need care at a lesser
level of care (for example a nursing home or rehabilitation facility),
may need care at home (home care) or may only need continued medical
supervision by the physician in his or her office. The patient
has completed treatment and no longer needs the medical care provided
in that particular service, for example, discharge from a hospital
emergency room. The patient
does not comply with the plan of care despite efforts to help him or
her understand the steps in the treatment plan and the importance
of treatment.
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In addition to the patient and his or her family (or friends), a variety of hospital staff can be involved in the discharge planning process.
- The physician – Only a physician can authorize discharge from the hospital
- The discharge planner – This may be a nurse case manager, social worker or another individual identified as the discharge planner. It is the discharge planner's responsibility to help the patient and/or family make any arrangements for continued care such as home care, nursing home care or outpatient treatment.
- The primary nurse – The nurse who coordinates the care the patient receives while in the hospital
- The rehabilitation therapists – If any were involved in the patient's care, for example physical therapists, occupational therapists, speech therapists, respiratory therapists, etc.
Discharge planning should
begin as soon as the patient enters the hospital. It is most effective
when the patient
and
his or her family are active participants in the discharge planning
process. A person may return to his or her home in essentially the
same condition
as prior to the hospitalization. In this case, there is little
planning to do. When there is a significant change in the patient's
ability to do things independently or, if he or she is in need of
specialized
care,
a
detailed plan is necessary. The discharge planner may make referrals
to community
services to help the patient during the recuperative period
following discharge; or, the discharge planner may assist the family
in locating another living
arrangement. The patient may be discharged
to a nursing home or a rehabilitation facility or to
an assisted living
facility.
| The Discharge Planner is the individual with the primary responsibility to coordinate the plan for your loved one's discharge. It is important for the process to begin as soon as possible. If the discharge planner does not contact you early on in the hospitalization, ask the primary nurse to help you contact him or her. |
| Tips For The Discharge Planning Process Keep
a notebook and write in it the names and telephone numbers of all the
staff involved in your loved one's care. Write
down any questions you have for the staff and the answers you get.
Mark the questions off as they are answered. Ask
for a functional evaluation of your loved one's ability to perform
activities of daily living if you are unsure how much he or she can do
independently. It is very helpful to know what your loved one will (and
will not) be able to do when discharged. Ask the physician and rehabilitation
staff how long after discharge your loved one will reach his or her highest
level of functioning. Find
your loved one's insurance information and keep it available.
You may need to contact the company to determine what services may be covered
after discharge. (The discharge planner can help you establish
eligibility for some services.) Document
any discussions you have with the insurance company. Always
ask questions and make sure you are comfortable with the plan before the
day of discharge. Speak
up and address any concerns you have with the staff. |
DISCHARGE INSTRUCTIONS
When the decision has been made to discharge your loved one from the hospital,
and you agree with the discharge plan, it is imperative that you and
your loved one receive written instructions prior to leaving the hospital.
What to Expect
- The physician will document the medical discharge instructions.
- The nurse will review the instructions with the physician.
- The discharge planner will coordinate with all team members to ensure that any services needed upon discharge have been put in place.
- The nurse will review the discharge instructions
with you and your loved one. This should include:
- A review of medications and how to take the medications (A schedule should be written.)
- A review of any treatments the patient will need and instructions on how to do the treatment
- Any adverse outcomes one might expect and information about who and when to call if you are concerned
- Any follow-up appointments you need to schedule
- A brief discharge summary for your loved one's primary care physician
| This is your opportunity to ask any questions about the follow-up care your loved one will need. |
- After the nurse reviews the instructions, arrangements will be made to transport the patient through the hospital to get his or her transportation home.
| APPEALING A DISCHARGE The primary physician is responsible for deciding when an individual is ready to be discharged. If the patient does not agree with the decision, he or she can appeal the discharge. |