Although discharge procedures seem relatively straightforward, there are many factors that healthcare providers must consider. A discharge for a patient who can perform self-care and is returning home may be easier to coordinate than that for an oxygen-dependent patient who is transitioning to a nursing home. These situations have the potential to become complex, resulting in frustrations for staff, patients and caregivers.
Well-planned and thorough discharge procedures improve patient outcomes by ensuring that the patients, receiving facilities, families and caregivers are equipped for the next phase of treatment and recovery. This time should be used to establish expectations, share information and arrange support services.
What Are Unsafe Discharge Procedures?
Discharges are likely to be unsafe if:
- The patient is discharged too early and is not in stable condition
- The patient has not received a complete assessment to determine physical health as well as social, emotional and mental status
- There is no cohesive aftercare or home care plan
- The patient’s family, friends or caregivers are not given sufficient time to prepare for the patient’s release
- The discharge is delayed due to poor communication and coordination with the receiving facility
How Are Discharge Procedures Evaluated for Effectiveness?
Discharge procedures often vary by facility and even by patient type, so tracking the effectiveness of your institution’s discharge practices can be challenging. One common way to do this is by looking at hospital readmissions. A reduction in readmissions typically indicates that discharge policies are safe, patients’ needs are being met and patients are given the support necessary to maintain their health and prevent deterioration in their condition.
Because hospital readmissions are a critical determining factor in patient outcomes, the Centers for Medicare & Medicaid Services (CMS) has established an initiative to assist facilities in improving discharge practices. The Hospital Readmissions Reduction Program (HRRP) is “a Medicare value-based purchasing program that encourages hospitals to improve communication and care coordination to better engage patients and caregivers in discharge plans and, in turn, reduce avoidable readmissions.” The program seeks to improve healthcare services by linking reimbursement to the quality of hospital care, which includes collecting data on patient outcomes and unplanned readmissions occurring within 30 days of discharge.
The inpatient nurse manager plays a key role in improving discharge procedures for patients. It is up to nurse managers and their teams to minimize the chance of readmission by ensuring efficient discharge.
How Do Improvements to the Discharge Process Enhance Patient Outcomes?
According to a December 2020 article published in Nursing2021, improvements to the discharge process can lead to:
- Higher patient satisfaction scores
- More discharges completed before 2 p.m. daily
- Reduction in time patients spend awaiting transfer to another unit
- Lower incidence of 30-day readmissions
- Improved identification and correction of safety issues and concerns
There are many ways to improve and streamline discharge procedures. Consider incorporating the following to create a more effective discharge strategy:
- Have a clear understanding of patients’ rights and the laws governing their care, including federal civil rights laws, and ensure discharge policies comply
- Use the five D’s checklist at every discharge: diagnosis, drugs, doctor follow-up, diet and directions, plus a final review of all discharge instructions
- Establish “discharge lounges” — a dedicated space and team to oversee care transitions
- Ensure a social worker or case manager has consulted with the patient and that in-home and community support services have been offered and/or arranged
- Fill prescriptions for the patient and schedule follow-up appointments with primary care and other providers
- Provide patients with customized discharge care instructions to help them navigate possible adverse events
Thoughtful Transitions of Care
Patient discharges can be complex, requiring a coordinated effort to ensure the patient has the tools and information necessary to prevent complications or readmission. A thoughtful and thorough approach to care transitions reduces stress and uncertainty, establishes patient expectations and improves outcomes. Inpatient nurse managers are an important part of the patient experience as the procedures they establish for their teams impact care quality.