1
Who makes the decision that a patient can be discharged?
Although residents, medical students, and other staff can anticipate a patient’s discharge, the attending physician makes the final decision regarding the appropriate time for patient discharge.
2
When is a patient determined to be appropriate for discharge?
The decision to discharge a patient from the hospital depends on resolving or stabilizing the acute medical issues that the patient originally presented with and the issues that may not be manageable in the outpatient setting. In addition, proper follow-up of laboratory results and diagnostic tests, as well as determination of transportation and destination upon leaving the hospital, will need to be arranged.
3
List the common steps involved in the discharge paperwork
The paperwork involved in the discharge process varies across institutions. A list of the common components of a typical set of discharge paperwork is displayed in Table 10-1 .
| Patient team information | A listing of the attending, residents, medical students, and other staff who were involved in the patient’s care. |
| Primary care physician | Name and contact information of the patient’s primary care physician and any other physicians who are involved in the patient’s outpatient care. |
| Diagnosis | The diagnosis the patient was treated for during this acute hospitalization and any previous medical diagnoses that the patient has been given. |
| Medications | A list of the medications and dosages prescribed for the patient to take upon discharge from the hospital. It is important to highlight the medication changes that have been made for the patient. |
| Unresolved issues | Any issues that physicians and staff should pay special attention to during outpatient follow-up visits. |
| Laboratory results | May include laboratory tests upon admission, any important laboratory results during the hospital stay, and any laboratory data that should be followed in the outpatient setting. |
| Procedures | A list of procedures performed during the inpatient stay along with any diagnostic results or complications of the procedures. |
| Follow-up | A list of the patient’s appointments for follow-up care after discharge from the hospital. |
| Patient education | Information regarding the patient’s hospital stay, medical diagnoses, and management of medical issues in the outpatient setting. |
| Discharge physical examination | A report of the pertinent positive and negative aspects from the physical examination on the day of discharge. |
| Clinical course | A summary of the patient’s clinical course during the inpatient stay, including a summary of the reasons for hospital admission, important events that occurred, and medical management during the admission. |
4
What should be included in the discharge physical examination?
Almost all hospitals require that a patient have a physical examination conducted by a physician on the day of discharge. A complete physical examination should be performed, with special attention being paid to any portions of the examination that are related to the patient’s reason for hospital admission. For example, if a patient was admitted for mental status changes, a Mini Mental State Examination and a full neurologic assessment should be performed. Other important items to include in the discharge examination are the patient’s weight and vital signs.
5
What are the possible locations that a patient can be discharged to?
The majority of patients will be discharged to go home. However, some patients may require additional medical attention that cannot be provided at home. The patient can either go home and have a visiting nurse provide some aspects of home medical care or he or she may go to another facility (such as an extended care facility) for further care. Common locations after discharge besides home include a subacute care facility, skilled nursing facility, rehabilitation center, nursing home, hospice, and long-term care hospital.
6
Describe the role of a discharge coordinator
The discharge process can become very complex with the large number of tasks that must be accomplished before completion of patient discharge. In fact, many larger institutions are now hiring a permanent staff member, referred to as the discharge coordinator, discharge planner, or discharge nurse, to facilitate many of the tasks needed to arrange for a patient to have a smooth transition out of the hospital. These may include arranging for ambulance pick-up, visiting nurses, durable medical equipment, and family assistance in determining an ideal extended care facility.
7
What is a discharge order?
The discharge order is the official order within the patient’s chart indicating that all other tasks have been completed, and the patient is ready to be discharged from the hospital. The order is commonly written in the same location (the patient’s written or electronic chart) as orders for medications and diagnostic tests. The order must include the location to which the patient is being discharged, such as home or another service. Some hospitals also require writing who the patient is being discharged with, such as father, daughter, or spouse. A typical order might be written as “Discharge patient home with spouse.”
8
How does a discharge affect the flow of patients through the hospital?
Each hospital has a maximum number of beds available. Once these beds are filled, no more patients can be moved to the inpatient floors for admission. The patients requiring medical care often face increased waiting times or may have to obtain care in the emergency department (ED) for an extended period. Sometimes hospitals will even tell ambulances to take patients to an alternate hospital if possible (called a diversion ). Once a patient is discharged, a number of events are set off as displayed in Figure 10-1 . Each discharge opens a bed for another patient who needs to be admitted. Once the newly admitted patient is transferred to the bed, a space opens up wherever that patient was, usually in the ED. This allows another patient to move from the ED waiting room into the ED to receive medical attention.
