Discharge from the hospital

Definition

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.

Description

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:

• Can this patient return to his or her preadmission situation?
• Has there been a change in the patient's ability to care for him- or herself?
• Is the patient in need of services to be able to care for him- or herself?
• Which services will the patient need?
• Are there mental health needs that must be met?
• Does the patient agree with the discharge plan?

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:

• a summary of the hospital stay
• a list of test and surgeries performed, with results
• a list of test results still pending
• a list of tests needed after discharge, such as a repeat chest x ray
• a list of medications the patient is being discharged with, including the dosage and frequency
• a copy of the patient's discharge instructions
• when the patient should see the primary care physician for a follow-up appointment
• the plan for outpatient treatment, such as home intravenous antibiotics or parenteral nutrition to ensure that responsibility for this treatment has been clearly transferred and that the primary care physician accepts the treatment responsibility
• discharge instructions to the patient on activity level, diet, and wound care

Before leaving the hospital, the patient will receive discharge instructions that should include:

• an explanation of the care the patient received in the hospital
• a list of medications the patient will be taking (the dosage, times, and frequency)
• a list of potential side effects of any newly prescribed medications
• a prescription for any newly prescribed medications
• when to see the primary care physician for a follow-up appointment
• home care instructions such as activity level, diet, restrictions on bathing, wound care, as well as when the patient can return to work or school, or resume driving
• signs of infection or worsening condition, such as pain, fever, bleeding, difficulty breathing, or vomiting
• an explanation of any services the patient will now be receiving, such as for a visiting nurse, and to include contact information

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 .

Resources

books

Wachter, Robert M., Lee Goldman, and Harry Hollander, editors. Hospital Medicine. Baltimore: Lippincott Williams & Wilkins, 2000.

periodicals

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.

organizations

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