Discharge from the hospital is the point at which the patient leaves the hospital and either returns home or is transferred to another facility such as one for rehabilitation or to a nursing home. Discharge involves the medical instructions that the patient will need to fully recover. Discharge planning is a service that considers the pa tient's needs after the hospital stay, and may involve several different services such as visiting nursing care, physical therapy, and home blood drawing.
Hospitalization is often a short-term event, so planning for discharge may begin shortly after admission. The physicians, nurses, and case managers involved in a patient's care are part of an assessment team that keeps in mind the patient's pre-admission level of functioning, and whether the patient will be able to return home following the current hospital admission. Information that could affect the discharge plan should be noted in the patient's medical record so that it will be taken into account when discharge is being scheduled. The primary questions include:
While a person has been in the hospital, physicians other than the primary care physician have been in charge of the patient's care. Good discharge planning involves clear communication between the hospital physician(s) and the primary care physician. This may be done by telephone and/or in writing. The information to be conveyed includes:
Before leaving the hospital, the patient will receive discharge instructions that should include:
The term discharge planning may be used to refer to the service provided to help patients arrange for services such as rehabilitation, physical therapy, occupational therapy, visiting nurses, or nursing home care. This service may be provided by a case manager or by the hospital's social service department. The patient may request this service, or the physician may make the request in the form of a referral to the department. The patient will need to be evaluated to see what services he or she requires, as well as what services he or she qualifies for (such as meals-on-wheels), or what services the patient's insurance will cover. The patient may be discharged home with a visit from a visiting nurse later the same day to assess the patient's need for these services and to make arrangements for him or her in the home. A person may be discharged home only when certain equipment such as a hospital-style bed and oxygen has been delivered to the home. If a patient feels he or she is being discharged before he or she is ready, the patient can file a complaint with the hospital's ombudsman.
A follow-up from the hospital staff, either physician, nurse, or case manager, should take place within two weeks of discharge to review the results of any tests that were done in the hospital that came in after the patient was discharged, to remind the patient of the follow-up appointment with the physician, to see if the patient has any questions about any new medications that were added in the hospital, and to be sure that no problems arose after discharge that have not been addressed. Such follow-up calls help to ensure a successful recovery.
A patient may experience a complication or an adverse effect as a result of care received in the hospital. The complication may be due to medication that was given, or from a test or surgery performed. In the February 2003 issue of The Annals of Internal Medicine, researchers reported how often these adverse effects arose, and how severe they were. Patients were interviewed by telephone a few weeks after discharge. About 20% had experienced an adverse effect such as a new or worsening symptom, medication-related problems, the need for an unexpected visit to the doctor, or death. Of the 20%, about one third had preventable adverse effects, and another third had problems that would have been less severe if they had received proper medical care. Three percent developed permanent disability.
See also Admission to the hospital .
Wachter, Robert M., Lee Goldman, and Harry Hollander, editors. Hospital Medicine. Baltimore: Lippincott Williams & Wilkins, 2000.
Forster, A. J., et al. "The Incidence and Severity of Adverse Events Affecting Patients after Discharge from the Hospital." Annals of Internal Medicine, 138 (February 2003): 161–167.
The American Hospital Association. One North Franklin, Chicago, IL 60606.
National Center for Health Statistics. National Hospital Discharge Survey, Vital Health Stat. 153 (November 2002): 1–194.
National Institute on Aging. http://www.nih.gov/nia .
Esther Csapo Rastegari, RN, BSN, EdM