Emergency Medicine

5 Things to Know About Hospital Discharges

A hospital discharge can be a complex transition. It’s easier if you understand the process.

Hospital discharges are quite complex. Patients are moving from an environment where they are surrounded by medical professionals around the clock to a less medical setting. The information relayed during hospital discharges is very important, but discharges usually happen quickly, because the hospital wants to have the bed available for the next patient. 

Before leaving the hospital, the patient will receive instructions about necessary follow-up appointments, medications, and equipment. The patient’s PCP and other providers may need updates on key medical information, and the patient may also have to arrange for care at home.

To make a departure from the hospital as simple and stress-free as possible, it helps to understand the process. Here are five things to know:

1. The hospital staff member managing discharges is very busy. Whether a patient is admitted to the hospital through the ER or is directly admitted, discharge planning begins immediately upon admission. A social worker or nurse case manager is typically responsible for discharges. As you may know, ERs and hospitals are often filled with patients seeking care, whether medical or psychiatric. Most hospitals have one social worker or nurse case manager for a unit of 30 or more patients.

You may wonder, "How can one social worker or case manager handle all of the discharges?" Hospitals are set up to efficiently move patients through the system. Getting patients out of the hospital quickly is critical to the operations and finances of the hospital.

2. Most hospital discharges aren't personalized. Case managers don't usually have the time to get to know every patient on their unit, evaluate their individual needs, and match them with a specific provider for follow-up care.

Instead, hospitals typically have a "discharge list" of doctors and facilities in different counties. For example, if a patient in metro Boston is discharged and needs an appointment with a cardiologist, the case manager has a list of cardiologists in Boston to which they can refer the patient. Hospitals have dozens of discharge lists, including nursing homes, home care agencies, and nutritionists, among others. Social workers and case managers typically quickly look at the appropriate list, match the patient's insurance, and make a referral.

3. Hospital discharges are opportunities for medical error. While medical errors are very rare, they are most likely to happen during transitions of care. When a patient is leaving a hospital to go home or move to another facility, the lack of continuity can be a challenge. It can lead to miscommunication, an interrupted medication regimen, or misplaced medical records, among other things.

4. Take notes during discharge. During a hospital discharge, the patient is given information and instructions about follow-up appointments, medication, and more. Even if you understand the next steps, you may not remember them all after you leave the hospital. Write everything down. If possible, have a friend, family member, or health advisor there with you.

5. A health advisor provides valuable support during the discharge process. A healthcare advisor can assist with discharging a patient from the hospital or ER, reducing the patient's stress level and easing the burden on hospital staff. The healthcare advisor meets with the patient to understand the situation, communicates directly with the treatment team, and assesses what the patient will need upon discharge from the hospital.

The health advisor also ensures that the patient receives quality follow-up care in their community to reduce further hospital and ER visits. The process a health advisor goes through to select a provider is thorough and personalized. Advisors conduct custom searches to find the providers and programs that best meet the patient's unique needs and preferences. An example:

65-year-old Debby was hospitalized and admitted to Lenox Hill Hospital for cardiac-related issues. Debby met with a cardiologist, pulmonologist, and general physician at the hospital. Debby was scheduled to discharge on a Saturday and needed follow-up care in NYC. As Debby's health advisors, we scheduled a team meeting with the three providers and her social worker in the hospital to discuss her care plan once she was ready for discharge. After discharge, Debby would need to follow up with her PCP and visit a cardiologist and pulmonologist.

We reached out to her PCP to provide an update on her admission at Lenox Hill and schedule a follow-up appointment for her once she was discharged. We also vetted and researched top cardiologists and pulmonologists near Debby's home to ensure that she would continue to receive top-quality care. We scheduled appointments for Debby, and attended them with her to offer personal support. We provide ongoing guidance toward reaching her wellness goals.

If you or someone you love could use help navigating the healthcare system before, during, and after an upcoming hospital visit, reach out to an expert health advisor.

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