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 discharge plan is necessary.
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. 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 in-patient medical unit) or discharge the patient from the hospital to any one of a variety of settings.
In most cases the physician initiates discharge for one of the following reasons:
- Medical Criteria: 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.
- Completed Treatment: 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.
- Incompliance: 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.
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. 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.
- Physician – Only a physician can authorize discharge from the hospital
- 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.
- Primary Nurse – The nurse who coordinates the care the patient receives while in the hospital
- Rehabilitation Therapists – If any were involved in the patient's care, for example physical therapists, occupational therapists, speech therapists, respiratory therapists, etc.
The Discharge Planner
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.
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.
Discharge Planning Tips
- Always ask questions and make sure you are comfortable with the plan before the day of discharge.
- 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.
- Ask the physician and rehabilitation staff how long after discharge your loved one will reach their highest level of functioning. Know what your loved one will (and will not) be able to do when discharged.
- Speak up and address any concerns you have with the staff.
- Write down any questions you have for the staff and the answers you get.
- Keep a notebook and write in it the names and telephone numbers of all the staff involved in your loved one's care.
- Document any discussions you have with the insurance company.
- 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.
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:
- Any follow-up appointments you need to schedule
- A review and written schedule of the medications and how to take the medications
- 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
- 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.