Is your patient ready to go home?

The process of discharging patients from the hospital usually goes smoothly, and the patients typically make a successful transition to home or some other setting. But once in a while, disaster strikes, as illustrated by the following cases:

What's sad about all these cases is that none of the patients was examined by a physician on the day of discharge. The doctors had written orders the night before, stating something like, "discharge in a.m. if vitals stable." If the physicians had evaluated these patients before they were discharged, perhaps some of the adverse complications could have been prevented, or at least treated sooner.

We spend considerable effort in the preoperative assessment of patients, evaluating their signs and symptoms as well as their chest X-rays, ECGs, and lab data. Likewise, when sick patients are admitted to the hospital, they get comprehensive evaluations by multiple specialists and plenty of diagnostic tests. By discharge time, however, many specialists have already signed off the case. Patients are assumed to be clinically stable, and there's a rush to get them out of the hospital. But, when you think about it, why should patients be treated less thoroughly on the day of discharge than on any other hospital day?

Therefore, we should be taking full advantage of the discharge process to educate patients and family members about diagnoses, medications, and follow-up plans. The day of discharge provides us with one last opportunity to make sure our patients are really stable and ready to leave. Here's a checklist I use:

Discharging patients from the hospital may seem simple, but often it's not. Performing discharges correctly takes time, energy, and considerable thought. A comprehensive approach, however, is well worth the effort. Not only can medical disasters be avoided, but proper discharge care provides physicians with a valuable opportunity to help patients make the often challenging transition from hospital to home or to another institution. Good discharge management represents medical care at its best.