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Discharge, Adios, Goodbye, Thank you for seeing me, Take care of yourself

Jul 15 / Tamala S. Bradham


Yes, I know that was the longest title ever but I got your attention!  Working in a hospital setting we often hear about discharges. How many were discharged last month, handovers, discharge summaries, patient’s perception of the discharge are just a few items that are tracked. 

In the outpatient world, discharges are just as important.  When the patient leaves your office, do they know what they need to do next? Hospitals and healthcare providers have a responsibility to ensure safety and efficiency when discharging a patient from their care.

 

Bear with me as I put on my researcher hat, patients are experiencing adverse events following discharge due to delayed or absent communication, inaccuracies in information exchange, and/or ineffective planning or coordination of care between providers (Hesselink, Schoonhoven, et al., 2013; Hesselink, Vernooij-Dassan, et al., 2013 ). 

In fact, at least 20% of patients report adverse events following discharge with at least half of these adverse events could have been prevented.

 

So what is your discharge or “thank you, goodbye” practice? Here are 5 takeaways to consider:

 

1)  Write it down! 

Discharge instructions should be written down for patient understanding, not for compliance and insurance companies.  Don’t worry about saving the trees, give the patient the recommendations/plan of care in writing.  And, if you have it available, the patient should be able to review them at any time on your secure, web-based patient portal that you have available.

 

2)  Share your instructions/plan of care with the patient’s medical home, therapists, and those that need to know! 

Handoffs are one of the biggest problems in how we care for patients and our clients that lead to adverse events.

 

3) Check for comprehension! 

Having the patient repeat back what they heard is essential.  Using techniques like “Teach Back” or motivational interviewing are great ways to check for comprehension.

 

4) Make the discharge follow-up phone call! 

Multiple studies show that if a simple phone call is made within 48 hours of the patient being seen or discharged from the hospital, it is a win-win for everyone involved.  For outpatients, not only will you keep that person as a patient; you will get more referrals due to having a happy customer.  For hospitals, research shows reduced readmission rates and significant cost savings!

 

5) Own the discharge process! 

When the patient leaves your practice/hospital, everyone who directly and indirectly touched that patient needs to own the process.  Does the patient know when to return?  Does the patient know who to contact if they have problems?  Will the patient tell a friend about the great experience they had?

 

Are you already doing these five simple things to keep patients safe?  If not, consider one of these for your next PDSA.

 

References:


  • Hesselink, G., Schoonhoven, L., Plas, M., Wollersheim, H., & Vernooij-Dassan, M. (2013).  Quality and safety of hospital discharge:  A study on experiences and perceptions of patients, relatives and care providers.  International Journal for Quality in Health Care, 25(1), 66-74.


  • Hesselink, G., Vernooij-Dassan, M., Pijnenborg, L., Barach, P., Gademanm, P., Dudzik-Urbaniak, E.,…Wollersheim, H. (2013).  Organizational culture:  An important context for addressing and improving hospital to community patient discharge.  Medical Care, 51(1), 90-98.


 

For more information about teach back, visit:


 

For more information about motivational interviewing, visit:


 

For more information about discharge phone calls, visit:



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About the blogger

Tamala Bradham, Ph.D., DHA, CCC-A, CPPS, CPHQ

For 25 years, Dr. Bradham’s career has always centered on developing and implementing new, innovative service delivery models to improve care delivery.

As a clinician, researcher, published author, and professor, she is a multi talented and multifaceted leader that inspires those around her to deliver best practices based on the current state of knowledge, explore opportunities to improve service delivery, and innovate solutions for the tomorrow.

As a partner with 3C Digital Media Network, Dr. Bradham will connect people with great talents and knowledge to the network, collaborate with others to improve and develop oneself, and communicate with genuine passion and transparency.

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