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Hospitals — getting out and staying out
A trip to the hospital can be an intimidating event for patients and their families. You and your family are focused completely on your medical treatment, and so is the hospital staff. You might not be giving much thought to what happens when you or your relative leaves the hospital.
The way this transition is handled—whether the discharge is to home, a rehabilitation (“rehab”) facility, or a nursing home—is critical to the health and well-being of your loved one. Studies have found that improvements in hospital discharge planning can dramatically improve the outcome for patients as they move to the next level of care and can help you avoid re-admission to the hospital.
Patients, family caregivers and healthcare providers all play roles in maintaining a patient’s health after discharge. And although it’s a significant part of the overall care plan, there is a surprising lack of consistency in both the process and quality of discharge planning across the healthcare system.
What is discharge planning?
Medicare says discharge planning is “A process used to decide what a patient needs for a smooth move from one level of care to another.” Only a doctor can authorize a patient’s release from the hospital, but the actual process of discharge planning can be completed by a social worker, nurse, case manager or other person. Ideally, and especially for the most complicated medical conditions, discharge planning is done with a team approach.
The discussion needs to include the physical condition of your family member both before and after hospitalization; details of the types of care that will be needed; and whether discharge will be to a facility or home. It also should include information on whether the patient’s condition is likely to improve; what activities he or she might need help with; information on medications and diet; what extra equipment might be needed, such as a wheelchair, commode, or oxygen; who will handle meal preparation, transportation and chores; and possibly referral to home care services.
Effective discharge planning can decrease the chances that your relative is readmitted to the hospital, help in recovery, ensure medications are prescribed and given correctly, and adequately prepare you to take over your loved one’s care.
Studies have shown that as many as 40 per cent of patients over 65 had medication errors after leaving the hospital, and 8.5 per cent of patients discharged from Canadian hospitals are readmitted within 30 days. This is not good for the patient and not good for the hospital. Research has also shown that excellent planning and good follow-up can improve patients’ health, reduce readmissions and decrease healthcare costs. Under the best of circumstances, the discharge planner should begin his or her evaluation when the patient is admitted to the hospital.
The family’s role
The discharge staff will not be familiar with all aspects of your relative’s situation. As family (caregiver), you are the “expert” in your loved one’s history.
The discharge planners should discuss with you your willingness and ability to provide care. You may have physical, financial or other limitations that affect your caregiving capabilities. You may have other obligations such as a job or childcare that impact the time you have available. It is important to tell hospital discharge staff about all this.
Some of the care your loved one needs might be complicated. It is essential that you get any training you need in special care techniques, such as wound, feeding tube or catheter care, procedures for a ventilator, or transferring someone from bed to chair.
Because people are in a hurry to leave the hospital, it’s easy to forget what to ask. Depending on the circumstances you may need to hire outside help for the following care responsibilities:
• Personal care
• Household care
• Emotional care
Effective discharge planning increases the well-being of patients and caregivers and can prevent readmission. It is often not given the attention it deserves, and ineffectual planning often adds to patients’ and caregivers’ stress and can increase the cost to the healthcare system.
• Wendy J. Scott (RN, BScN, MA) is owner and director of care of Nurse Next Door’s Burnaby/New West/TriCities office. Reach her at 604-522-9989 or email@example.com.