In my last blog post, I discussed hospital readmissions and offered some solutions on how to prevent this growing problem within our health system. Of those solutions, I would like to take a closer look at hospital discharge planning and how this simple task in the transition of care can help alleviate the $12 billion we spend in preventable hospital readmissions each year.
Definition
Discharge planning is described by Medicare as, “A process used to decide what a patient needs for a smooth move from one level of care to another1.” Though only a doctor can authorize a patient’s release from the hospital, the actual process of discharge planning is a team effort.
Significance
According to the Agency for Healthcare Research and Quality (AHRQ), the hospital discharge process is often fragmented, highly variable, and haphazard and as a result, newly discharged patients can develop complications that lead to hospital readmission2. “National statistics have shown that most errors occur during transitions in care from one care setting to another. Without appropriate preparation and coordination, necessary information, testing, and services fall through the cracks causing an additional strain on patients, families and resources,” says Robin Jones, RN, quality improvement coordinator at Valley Baptist Medical Center3
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 while decreasing healthcare and social costs4/5. Effective discharge planning can decrease the chances of being readmitted to the hospital, help in recovery, ensure medications are prescribed and given correctly, and adequately prepare caregivers to take care of the patient2. Given the fact that hospitals will be penalized for having a poor readmission rate, it would be of great benefit for hospitals and providers to begin to implement a solid transition or care/discharge plan.
Plan
The Boston Medical Center, supported by grants from the Agency for Healthcare Research and Quality and other federal programs, has developed a groundbreaking discharge planning process known as Project Re-Engineered Discharge, or Project RED6. Richard Scott, from Dorland Health, has reproduced the 11 component process that has shown to reduce avoidable readmissions and boost patient satisfaction6:
Educate the patient about his or her diagnosis throughout the hospital stay.- Make appointments for clinician follow-up and post-discharge testing. and
- Make appointments with input from the patient regarding the best time and date of the appointment.
- Coordinate appointments with physicians, testing, and other services.
- Discuss reason for and importance of physician appointments.
- Confirm that the patient knows where to go, has a plan about how to get to the appointment; review transportation options and other barriers to keeping these appointments.
- Discuss with the patient any tests or studies that have been completed in the hospital and discuss who will be responsible for following up the results.
- Organize post-discharge services.
- Be sure patient understands the importance of such services.
- Make appointments that the patient can keep.
- Discuss the details about how to receive each service.
- Confirm the Medication Plan.
- Reconcile the discharge medication regimen with those taken before the hospitalization.
- Explain what medications to take, emphasizing any changes in the regimen.
- Review each medication’s purpose, how to take each medication correctly, and important side effects to watch out for.
- Be sure patient has a realistic plan about how to get the medications.
- Reconcile the discharge plan with national guidelines and critical pathways.
- Review the appropriate steps for what to do if a problem arises.
- Instruct on a specific plan of how to contact the PCP (or coverage) by providing contact numbers for evenings and weekends.
- Instruct on what constitutes an emergency and what to do in cases of emergency.
- Expedite transmission of the Discharge Resume (summary) to the physicians (and other services such as the visiting nurses) accepting responsibility for the patient’s care after discharge that includes:
- Reason for hospitalization with specific principal diagnosis.
- Significant findings. (When creating this document, the original source documents – e.g. laboratory, radiology, operative reports, and medication administration records – should be in the transcriber’s immediate possession and be visible when it is necessary to transcribe information from one document to another.).
- Procedures performed and care, treatment, and services provided to the patient.
- The patient’s condition at discharge.
- A comprehensive and reconciled medication list (including allergies).
- A list of acute medical issues, tests, and studies for which confirmed results are pending at the time of discharge and require follow-up.
- Information regarding input from consultative services, including rehabilitation therapy.
- Assess the degree of understanding by asking them to explain in their own words the details of the plan.
- May require removal of language and literacy barriers by utilizing professional interpreters.
- May require contacting family members who will share in the care-giving responsibilities.
- Give the patient a written discharge plan at the time of discharge that contains:
- Reason for hospitalization.
- Discharge medications including what medications to take, how to take them, and how to obtain the medication.
- Instructions on what to do if their condition changes.
- Coordination and planning for follow-up appointments that the patient can keep.
- Coordination and planning for follow-up of tests and studies for which confirmed results are not available at the time of discharge.
- Provide telephone reinforcement of the discharge plan and problem-solving 2-3 days after discharge.
Resources cited in this blog:
- http://www.docstoc.com/docs/48117535/The-Importance-of-Hospital-Discharge-Planning
- http://www.innovations.ahrq.gov/content.aspx?id=1777
- http://www.dorlandhealth.com/clinical_care/best_practice/7-Steps-for-Robust-Discharge-Planning-and-Reduced-Readmissions_1790.html
- http://www.nurseweek.com/features/99-6/discharg.html
- http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=2312
- http://www.dorlandhealth.com/case_management/best_practice/The-11-Components-of-Project-RED_1791.html
- http://en.wikipedia.org/wiki/Transitional_care
