For many people who have been in the hospital for an illness or surgery, the best part of the experience is leaving the hospital.
But leaving a hospital is not as simple and straightforward as leaving an airport (although there are some eerie similarities between hospitals and air travel, including inexplicable delays and strange-looking food). The process of leaving a hospital can appear mysterious to the uninitiated. Here are some explanations and guidelines that may help smooth transition for you or your loved one.
Discharge, not release
A hospital is not a prison. No one is ever released from a hospital, though the word “release” is most often used to describe the process. The proper term is ‘”discharge,” meaning simply that a person leaves the institution and goes someplace else. The word discharge may conjure images of patients being spit out onto the street like so many watermelon seeds. Fortunately, that’s not what typically happens! The process of leaving the hospital should be carefully planned at every stage by teams of nurses and administrators (discharge coordinators), whose primary responsibility is hospital discharge.
Among the important decisions you or your loved one makes with discharge coordinators is the destination after leaving. Not everybody goes home from the hospital (although this is increasingly becoming the case). The patient may have needs that are not so serious that only a hospital can provide them (e.g., constant monitoring or intensive nursing needs), but may have needs that cannot be managed at home (e.g., inability to walk or take care of oneself). In those cases, you or your loved one may decide with the discharge team to go to a long-term care facility or a rehabilitation center. Finally, even if the patient is not back to 100%, discharge to home may be a possibility. Many needs that previously could only be handled in a hospital, including intravenous medications, can now be given at home with the aid of specialized home health nurses.
Physicians and discharge coordinators are not the only members of the team involved in making discharge decisions. Your preferences or the preferences of your loved one are equally important. If you decide as a team to go to a long-term care facility after discharge from the hospital, the team will find the best match for the patient for delivery of services, proximity to family, and acceptance of medical insurance. If home is the discharge destination, the discharge coordinator will set up any home nursing needs, including equipment (e.g., crutches, commodes), and visits from specialized nurses (IV medication nurses, physical therapists, occupational therapists, etc.) Finally, the team will set up follow-up appointments with doctors and surgeons. Discharge instructions and prescriptions are provided in writing, sometimes even in booklets where all the information can be accessed conveniently.
Keeping in contact
Communication is key. Even though the term is “discharge,” you or your loved one are not being thrown out into the world without some connection to your care givers. Along with the discharge instructions, there should be a list of phone numbers (sometimes even email addresses) so that you can re-establish contact if any questions or problems arise after leaving the hospital.
How to keep from going back
The purpose of a stay in an acute-care (higher intensity) hospital is to address an immediate problem and help the patient get ready to move on with life. Nobody, least of all the patient, wants to go back to the hospital for the same problem. In fact, because readmission to a hospital is considered in some sense a failure to take care of the illness, hospitals keep detailed records of hospital readmissions within a month of discharge, in order to prevent them from occurring in the future. There are two of basic principles to know to avoid going back to the hospital:
- If the patient does not feel ready to leave the hospital, for whatever reason, these concerns should be brought to the medical staff. At the very least, the concerns can be discussed. At most, you may end up giving the discharge staff some important information that can guide safe and effective treatment after the hospital.
- Falls in the home are a major cause of hospital readmission. Make sure there is a thorough discussion with discharge staff about any possible hazards at home that may increase the risk of falling.
Inpatient hospital stays play an important role in helping seriously ill patients heal. The next step after a hospital stay is a crucial one. Proper discharge planning by the hospital and family, post-acute support, and patient awareness go a long way to making a smooth transition of care.