Most people preparing for a hospital stay are concerned with the procedures, but what happens after can be equally influential. Hospital discharge requires a lot of time, care and consideration as the patient heals and adjusts to life outside the hospital.
“An effective hospital discharge plan is important to decrease the chance of the patient being readmitted to the hospital as well as helping to improve the patient’s outcome for a full recovery,” said Roxanne Hart, RN, Director of Case Management at Southern Hills Hospital and Medical Center. Knowing what steps to take, what to expect and what to ask can help streamline the process and lessen stress during the time of transition.
How does the process work?
The discharge planning process begins the day you’re admitted to the hospital. Depending on the circumstances for admittance, any scheduled procedures and your medical history, the early stages of the plan will be outlined accordingly. The discharge plan will likely be a multistep process that requires careful coordination between you, your caregiver and your care team.
“Discharge planning is usually done using a team approach,” Hart said. This can mean doctors, nurses, case managers, social workers and more.
Each team member plays an important role. Physicians assess the patient’s progress and authorize his or her release from the hospital. A case manager — usually a registered nurse who has been trained in managing discharge cases and extended care — will evaluate his or her needs for a safe discharge. Case managers do this by interviewing the patient, following the physician’s orders and considering the recommendations of the patient’s bedside nurse and other team members. A physical therapist or occupational therapist will assess the patient’s ability to perform daily activities once discharged and will make further recommendations for extended care if necessary.
It’s important that every patient feels heard during the discharge planning process and feels confident and comfortable with the plan once they leave the hospital. “The patient or a family member can request discharge planning assistance at any time during their admission. They should also ask plenty of questions and speak up if they’re worried about anything,” Hart said.
Once the discharge plan is completed and the appropriate referrals are made, the patient will be discharged from the hospital and begin the adjustment period back into normal life.
• Designate a caregiver, especially if your discharge plan requires extended care. Your caregiver can be a family member, spouse or close friend, but it must be someone you trust to carry out your discharge plan and speak candidly on your behalf.
• Ask questions and be sure both you and your caregiver fully understand the discharge plan. Take notes and write down any further questions you may have.
• Work with your case manager and/or social worker to ensure that you fully understand your options and that your discharge plan is appropriate for you and your lifestyle. Your case manager or social worker will be able to advocate for you if need be.
• Review your discharge instructions once you get home to reinforce any actions needed.
• Follow up with your primary care physician 7-10 days after discharge so he or she knows about your hospitalization and can follow your care plan. Be sure to let him or her know if you have any additional concerns.
• Don’t hesitate to ask about different options, especially if you’re having trouble paying or are worried about the ongoing cost of care. “If you cannot afford a medication or treatment, please speak with your team about it because there may be a less expensive option available,” Walker said.
Dealing with prescriptions
Fill any prescriptions before you’re discharged so they’re ready to take as soon as you get home. “The drugstore pharmacist can be a great resource — they’ll answer questions about your medications and give you additional follow-up information,” said Deborah Walker, Director of Case Management at MountainView Hospital.
It’s also important that patients don’t stop taking their medications just because they begin to feel better. “If you stop taking your medicine, you will likely get worse and feel worse soon. Always finish your full course of medication,” Walker said.
Advice for caregivers
Sunrise Hospital and Medical Center outlines questions caregivers should ask as they prepare for the discharge of a loved one.
• What is the next step for medical care? (i.e. home care, physical therapy, occupational therapy, etc.)
• What new medications should the patient be taking, and what former medications should they continue to take?
• What potential health warning signs do I need to watch out for, and what should I do if they happen?