Every hospital patient’s health care journey transpires in two stages. The first is the period in which the patient is in the hospital, under the watchful eye of physicians and nurses. In this stage, a team of health care workers caters to the patient’s every need. Everything from medications to treatments to food is provided on a schedule that ensures the best patient outcome.
However, there comes a point when every patient must transition from the hospital to home or a skilled nursing or rehabilitation facility. The transition from inpatient to outpatient care introduces the topic of hospital discharge planning, which is one of the most important parts of ensuring that patients know how to care for themselves while on the road to recovery.
According to a 2021 BMJ Open Quality article on how to simplify discharge instructions, “Patients who do not have enough information about their discharge plans have decreased treatment compliance, decreased patient safety, increased emergency department (ED) recidivism, and poor satisfaction.”
Hospital discharges are essential to patient recovery. However, the BMJ Open Quality study found that written discharge instructions were long and tedious, important information was difficult for patients and their caregivers to locate, and most patients didn’t fully understand their return to the emergency department indications. The plans themselves aren’t problematic, but how the information is conveyed leaves much to be desired, potentially putting patients at risk.
What Is a Hospital Discharge Plan?
“Discharge” is a term that hospitals use internally to refer to the end of an inpatient stay and the beginning of outpatient recovery. Being an outpatient doesn’t always mean returning home. It can also mean staying in a nursing facility or with a designated caretaker. Whatever the case, the hospital discharge plan is the most critical part of a patient’s successful transition.
The plan is included in the hospital discharge papers. It contains detailed information about patients and their conditions, instructions to follow (when to take medications, how to care for a wound), and a list of resources available to support recovery and reduce the chance of being readmitted to the emergency department.
All patients are unique and will have different preferences in how they approach recovery, which is why the most effective hospital discharge plans are developed using the input of both patients and their caregivers. Discharge plans that include the patient’s needs and preferences are generally easier for the patient to follow.
What Are Hospital Discharge Papers?
Discharged patients are given hospital discharge papers, also referred to as hospital discharge summaries. Discharge papers are physical documentation of the patient’s stay that also includes instructions for treatment and follow-up care.
The key components of hospital discharge papers include the following:
- The reason the patient was hospitalized that includes a detailed description of the primary condition being treated
- The diagnosis of the primary condition and key findings
- A detailed breakdown of treatments or procedures, including dates and times
- A summary of the patient’s condition upon discharge
- Instructions for the patient (and caretaker, if applicable), also known as the hospital discharge plan
- The signature of the attending physician
What Is Included in a Hospital Discharge Plan?
Although no two patients are identical, hospital discharge planning is a process that must factor in all the variables of the patients, their conditions, their ability to care for themselves and the resources at their disposal. Although no two hospital discharge plans are identical, some standard elements are the following:
- A detailed description of medical issues, including allergies
- A list of all medications, how and when to take them and any relevant change or stop dates
- Detailed instructions for changing bandages or dressings
- Dates and times of medical appointments, including names and numbers of providers
- Contact information for who to call with questions or during an emergency
- A list of foods that are allowed and not allowed
- Guidelines to follow regarding activity levels and any unadvisable activities, such as lifting heavy objects or climbing stairs
A physician or another health care staff member generally reviews the hospital discharge plans with the patient in person. Family and caregivers are also included in the process to help bring them up to speed on the discharge planning process.
Why Hospital Discharge Planning Is So Important
Inpatients receive the highest level of care available and have access to various resources to help them overcome health care challenges. However, patients are discharged when they no longer require the top-level care a hospital provides, according to Johns Hopkins Medicine. This means that patients are well enough to leave the hospital, but may still face a long road to full recovery.
After a patient is discharged, the safety net of the hospital and all its resources is no longer readily available. Patients must either be well enough to care for themselves or be in the hands of devoted caregivers; this is why hospital discharge planning is so important.
For example, patients may still have wounds that are still healing or medical conditions that require close monitoring and a strict medication regimen. Additionally, patients and caregivers need to know what their resources are in the event of an unexpected issue or a sudden decline in the patient’s condition.
Ideally, hospital discharge planning means patients have full comprehension of their medical condition, how to properly manage it on their own, who to contact for questions and what indicators to look for that would justify a return to the hospital. An effective hospital discharge plan is comprehensive but easy to understand. It also factors in the many what-ifs that could arise and how to handle them.
Your Hospital Discharge Planning Checklist
When going through the discharge planning process, patients and caregivers interact with various personnel before leaving the hospital. In most cases, patients end up collaborating with nurses, social workers, or specialized health care workers known as discharge planners.
To get the most out of their hospital discharge planning and increase its chance of success, patients and caregivers are encouraged to proactively ask questions and bring up special needs or personal preferences that may affect the plan. Additionally, the discharge plan must include contact information and resources for care and emergencies.
The best way to ensure that nothing is overlooked is to create a hospital discharge planning checklist. Online resources and literature suggest the following critical items for a discharge planning checklist:
- Arrange for caregivers and care location.
- Inform yourself about your condition.
- Review your medications and health supplements list with the hospital staff.
- Prepare for recovery support, such as activities, medical equipment, and wound care.
- Arrange for family services, such as support groups.
- Arrange for pickup of prescriptions or special dietary accommodations ahead of time.
- Ask for a written hospital discharge plan with instructions you can understand.
What Is an Unsafe Discharge from a Hospital?
Hospital discharge planning should be handled safely and responsibly to ensure positive outcomes; however, sometimes discharge planning is handled improperly and puts patients at risk. When considering what unsafe discharge from a hospital is, here are signs to look for and some commonly occurring elements that patients may encounter.
A patient may not be mentally or emotionally ready to leave the hospital, which is normal. However, one of the biggest risks to patients being discharged is that the hospital may do so before they’re medically ready to leave. Premature hospital discharges put patients at increased risk of readmission or a trip to the emergency room. Typically, the primary risks of a discharge are addressed during the hospital discharge planning stage.
Unsafe discharge from a hospital can occur when a patient takes it upon themselves to vacate the facility against medical advice (AMA). The number of patients who leave hospitals AMA is approximately 2 percent or less, according to findings published in the journal Healthcare. While that’s quite a small number of patients, that group is at the highest risk of worsening conditions or death. The most common reasons patients leave AMA to include the following:
- The patient was dissatisfied with the quality or timeliness of the treatment.
- The patient didn’t want to undergo a certain procedure or type of care.
- The patient didn’t want to be responsible for the cost of health care services.
- The patient had prior obligations, such as family or work.
Another unsafe hospital discharge scenario is when patients are medically ready to be discharged, but either misunderstand the instructions or don’t follow through on every element of the discharge plan. For example, they might forget to take their medication on time or choose not to follow the proper steps for wound care.
The main reasons that patients might misunderstand or not completely follow the hospital discharge plan include the following:
- Difficulty understanding medical terminology or technical jargon
- A language barrier or cultural differences
- Financial challenges or other roadblocks that prevent them from getting follow-up care and essential medications
Be an Active Participant in Hospital Discharge Planning
Patients need to be directly involved in the process of hospital discharge planning. Their active participation mitigates the risk that they’ll need to be readmitted to the hospital or return to the emergency department. It also benefits patients to be vocal about their preferences and concerns when forming a discharge plan. Doing so makes the transition process easier to handle and paves the way for positive health care outcomes.