Leaving the Hospital: Your Hat, Coat and Discharge Papers

Leaving the Hospital: Your Hat, Coat and Discharge Papers

Recently a client was discharged from a hospital here in Westchester County. He was brought to the ER from his assisted living residence as a result of complaints of dizziness and unexplained confusion. As the trip to the hospital occurred in the middle of the night, for reasons I will never understand, the necessary list of his current medications were not given to the EMS driver, or the driver neglected to give them to the ER department. When he was ultimately discharged from the hospital (a diagnosis of dehydration), the discharge medication list bore little resemblance to the medications he was taking at his residence. His longtime doctor surmised in lieu of not having a current medication list, the hospital relied on medication records from years before. What occurred was inexcusable. Yet, if it wasn’t for the discharge summary that accompanied him back to his residence, this medication tsunami would never have come to light. Discharge summaries, which are given to the patient or family at the time of departure, are essential for a smooth transition to wherever the patient will be going.

A hospital will discharge a patient when they no longer need to receive care within the confines of a hospital. Because hospitals follow formularies set forth by Federal guidelines, discharge can occur before a family believes their relative is ready. The family has the right to appeal the discharge by calling the Quality Improvement Organization (QIO) Livanta at 1-866-815-5440. An independent determination is made within 24 hours and if discharge is to occur, the patient has to be out of the hospital by 11AM the following day. But assuming the discharge is occurring at a safe and appropriate time in the recuperation process, discharge summaries are essential. A discharge planner will stop by the patient’s room and meet with the patient, the family or significant others and help to coordinate the care one will need after leaving the hospital. If rehabilitation is necessary, the discharge planner will have already asked for the names of three to five rehabilitation centers that are situated in nursing homes. The services of an elder care consultant or an aging life care specialist can be extremely helpful at this juncture as we are familiar with those rehabilitation centers that provide quality care.

One should bear in mind, that even though a loved one may be discharged from the hospital it may not mean that he is fully recovered. The person may need a lesser level of care that the hospital has determined can be provided at home with or without the services of a visiting nurse. If a person is in the hospital for a day or so and is otherwise in good health, there may be no need for any type of nursing care once home. The discharge planner, who is usually a nurse, will explain this. However, if the patient came into the hospital and was already compromised medically, chances are their discharge papers will indicate that a visiting nurse will be coming to the home within 24-48 hours after discharge. The nurse will do an assessment to determine what kind of follow-up services are needed by the person including physical therapy. If there is a need for medical equipment, the visiting nurse will assist the patient and family in obtaining what we call DME: durable medical equipment. It will be ordered from those sources that are designated as Medicare providers. If a family chooses to go to a source not recognized by Medicare, they will pay out of pocket for such equipment such as a commode, walker, or bedrails.

The discharge papers will also list medications. Sometimes a patient will leave the hospital and continue on the same medications he was on before. Other times, based on a new diagnosis, a medication will be eliminated and another one started. Usually, the discharge planner will call in the new prescriptions to the person’s pharmacy. With these medication changes and possible new diagnoses, the discharge papers will tell you what doctors followed the patient in the hospital and who the patient should follow-up with after discharge. Unfortunately, when the directions are to follow-up with an internist in a week or ten days, it may be challenging to get an appointment within that time period. I have found here in Westchester County one can wait weeks for the discharged patient to see their internist. If the discharge papers read to follow-up with a specialist, and you are a new patient, the wait can even be longer.

If time permits, prior to the discharge, the patient and the family should compile a list of questions they have about next steps. It is essential to keep in mind that discharge planners are working under a timeline. When those discharge papers say it’s time to leave, it’s time to leave. Paying out of pocket for even an extra day can cost thousands of dollars.