The discharge of a patient from the hospital is a critical transition point in their care journey. A well-planned, safe discharge process is crucial for avoiding adverse events and unnecessary readmissions. Hospital discharge policies outline the procedures and safeguards needed to ensure patients fully understand their discharge instructions and have the necessary follow-up care in place. In this blog post, we will examine the key elements every hospital should include in their patient discharge policy.
Introduction
Discharging a patient from the hospital carries many potential risks if staff do not handle the process carefully. Patients may fail to fully grasp discharge instructions, especially if they have complex medical conditions, cognitive difficulties, or limited language proficiency. Details can fall through the cracks when care transitions from the hospital to other providers. A lack of follow-up care and services after discharge can lead to complications or medication errors. That is why hospitals need a comprehensive, patient-centered discharge policy. An effective policy establishes standards and procedures to ensure staff conduct discharges safely and patients understand their next steps in recovery.
Core Elements of a Discharge Policy
A robust hospital discharge policy will generally incorporate the following key elements:
Discharge Planning Process
The policy should outline when discharge planning begins, who is involved, and how the patient and family members are included in the planning process. Planning may begin upon admission for straightforward discharges or within 48 hours of anticipated discharge for medical patients. A multidisciplinary team of case managers, social workers, nurses, therapists, and physicians collaborate on the discharge plan. The patient and family must be oriented to this process and kept informed of the plan’s progress.
Discharge Readiness Assessment
Before the patient leaves the hospital, the care team must ensure the discharge criteria are met, which may involve vital signs within normal limits, pain controlled by oral medication, favorable lab result trends, etc. The medical team confirms the patient has achieved the discharge goals outlined in the treatment plan.
Patient Education and Training
A central component of safe discharge is education for the patient and family on medications, warning signs to monitor, infection control, proper nutrition, scheduled follow-up appointments, and more. Teach-back education should be used to confirm understanding. Caregivers may also need training on medical tasks like changing dressings or operating equipment.
Medication Reconciliation
An accurate list of discharge medications must be reviewed with the patient. This includes prescription instructions, potential side effects, and medication safety. Any changes from admission medications should be explained clearly.
Discharge Summary Communication
On the day of discharge, the care team should send the patient’s primary care provider a discharge summary detailing treatment, recommendations, medications, and follow-up items. Patients should leave with a printed discharge summary as well as a follow-up phone call within 3 days.
Post-Discharge Follow-Up
The discharge plan should include proper arrangements for any necessary home health services, outpatient therapy, durable medical equipment, etc. The care team must schedule follow-up appointments with providers and ensure they are accessible for the patient.
Standardized Discharge Checklists
Checklists help staff ensure they address all discharge components, such as confirming medications, providing education, arranging transportation, transmitting records, and reviewing warning signs with the patient. Nurses should complete the checklist prior to discharge.
High-Risk Discharge Protocols
For certain high-risk patient populations, additional precautions should be in place:
- Elderly patients with cognitive difficulties may need enhanced education with frequent comprehension checks. Caregivers should be involved.
- Limited English proficiency patients require professional interpretation services and translated written materials.
- Uninsured and low-income patients may need greater assistance connecting with community resources, free clinics, medication assistance programs, etc.
- Patients with mental illness or substance abuse disorders require tailored counseling and coordination with behavioral health services.
- Any patients with chronic, complex conditions will need thorough training for self-management at home.
Conclusion
While transitioning a patient from the hospital to home or another facility may seem straightforward, unsafe discharges can lead to medication errors, acute complications, and unnecessary readmissions. That is why a comprehensive discharge policy is a crucial component of patient care. Following structured protocols for discharge readiness assessments, patient education, medication safety, follow-up coordination, and special high-risk populations will go a long way in preventing adverse discharge outcomes.
