Tips for Hospital Discharges

When it’s time for you or a loved one to leave the hospital, you may feel both happy and stressed. You may feel joy that you will soon be home in your own bed. But you might worry that you, or your loved one, are too sick to go home. Or you might worry that you cannot handle the required daily medical tasks. What seems like a positive step is often filled with fear and concern, and the cause for concern is not unfounded. Our tips for hospital discharges can make the transition to home a bit easier, and safer, for you or your loved one.

The transition from hospital to home can be hazardous for patients and caregivers. Although this post focuses on discharges from hospital stays, patients going home after staying in rehabilitation facilities face similar issues. Following my tips for hospital discharges, which generally apply to rehab discharges, can reduce the risk of complications.

Note – many patients go to long-term care facilities after a hospital stay. Although cared for by professionals at these facilities, this transition also carries risk of patient harm. However, this post focuses specifically on transitions to a home environment from either a hospital or rehabilitation facility.

For information on nursing homes and long-term care facilities, read my blog posts Nursing Home Safety Issues and How to Choose a Nursing Home.

Why is the time after hospital discharges dangerous?

Sending home sick patients with complicated medical needs increases the risk of dangerous complications and infections – which can lead to serious health consequences and hospital readmissions. Which is exactly why you need to consider my tips for hospital discharges!

Importantly, research shows that after hospital discharges, patients frequently deteriorate, leading them either to the emergency department, back into the hospital, or into a period of functional decline. For example, the risk of death increases in the month after discharge for older patients hospitalized with heart failure, as compared to the risk during their initial hospital stay.

Moreover, patients are so vulnerable during this period, they may deteriorate due to medical conditions that were not the cause for their initial hospitalization. This period, called post-hospital syndrome, exposes patients to a new, temporary period of risk from a wide range of medical problems.

How do hospitals make discharge-related decisions?

Firstly, only a patient’s doctor can determine if a patient is medically ready for discharge.

However, another staff member, such as a dedicated discharge planner or a social worker, will likely oversee the actual discharge planning. Importantly, discharge planning should be a team effort with input from the patient, family and/or other loved ones, a case manager, nurses, doctor(s), physical and occupational therapists, a social worker, and the patient’s insurer.

Once a doctor clears a patient to leave the hospital, the team must decide if the patient should go home, or to a facility for rehabilitative, transitional, or chronic care. To make this choice, the team must consider the patient’s medical needs, his/her potential for rehabilitation, and social aspects such as housing and the availability of family or friends to help out.

Ideally, the team should consider non-medical factors, including:

• A patient’s cognitive abilities.
• A patient’s activity level and functional status.
• The nature of the patient’s current home and suitability for the patient’s conditions (e.g., presence of stairways, cleanliness).
• The availability of family or companion support.
• A patient’s ability to obtain medications and services.
• The availability of transportation from hospital to home, as well as for follow-up visits.
• The community services available to help the patient with ongoing care.

What advice should you receive during discharge planning?

Importantly, a discharge plan indicates not only where the patient should go upon leaving the hospital, but it also must address a variety of factors to make sure the patient recovers safely, with little chance of complications and a potential hospital readmission.

Although each hospital uses their own planning process, discharge plans generally include:

• A doctor’s evaluation of the patient.
• Involvement of the patient and/or a family member or other representative.
• Reconciliation of medications to review prescriptions needed upon discharge. This process must make sure there will be no duplications, omissions, harmful side effects, or drug interactions. And the plan must include instructions on when and how to take each medication.
• Planning for getting the patient home or to another care facility.
• Determining what kind of caregiving training or support is needed.
• Referrals to a home care agency and/or appropriate community support organizations.
• Arranging for follow-up appointments or tests.
• A list of who to contact if issues arise, including contact information for a “go-to person” for care questions, plus a phone number for 24/7 urgent help.

It can be hard to understand and remember discharge instructions.

Certainly, understanding discharge instructions helps you (or your loved one) know what to do next, which can help you recover and remain healthy.

However, at the time of discharge, there is a lot of information for patients and families to digest. Hopefully, staff members take the time to carefully explain next steps, including home care needed, medication changes, and needed follow-up appointments. And ideally, staff should make sure patients and families feel confident in their ability to perform any required tasks.

Most patients don’t correctly remember what they hear.

Research shows that patients struggle to correctly remember what they hear during doctor appointments. For instance, one study found patients quickly forget 40-80% of medical information provided by healthcare professionals. Unsurprisingly, the more information heard, the higher percent forgotten. Moreover, of the information that was remembered, almost 50% of the information was remembered incorrectly.

It’s not a huge leap to expect that patients (and families) would also struggle to correctly remember medical information after a hospital stay. Unsurprisingly, if you’re a hospital patient, you likely feel sick, stressed, and exhausted, which makes it hard to absorb information.

In fact, in a recent study, researchers interviewed patients within 24-48 hours of their discharge. They asked patients about 4 key subjects: diagnoses they were treated for, types of inpatient treatment received, post-discharge treatment plans, and any medication changes.

• 58.5% – remembered their diagnoses
• 64% – remembered the types of treatments received
• 51% – remembered their post-discharge treatment plans
• 43% – remembered medication changes

At the end of this post you’ll find tips for hospital discharges that can help you avoid problems.

For more information on remembering and understanding medical information, read these posts:

• Majority of Patients Don’t Understand Discharge Instructions
• Understanding Medical Information Is Harder Than Most Realize

Why should family be involved in the discharge planning process?

One of the most important tips for hospital discharges is to get involved in the process! When family members participate in the planning process, they can ask questions about the diagnosis, expected progress, potential complications, the types of help their loved one will need, and more.

Additionally, they can offer insights on the patient and his/her situation, such as conditions at the patient’s home and the availability of family support. And family members can provide an honest assessment of their loved one’s ability to stay on top of their care, including taking medication as prescribed and handling other required medical tasks.

Similarly, if family members will be helping out, they should share any restrictions that would make any or all of the caregiving responsibilities difficult. In other words, if family members have physical, financial, family, work, or other limitations that could affect their caregiving capabilities, they must speak up during this planning process.

By asking questions and providing insights, family members will be more equipped to participate in the decision-making process, which can make the transition to home easier and more successful.

Interestingly, an analysis of 15 studies found that systematically integrating family caregivers of older patients into the discharge planning process led to a significant reduction in readmissions. Specifically, involving caregivers was associated with 25% fewer readmissions at 90 days after discharge and 24% fewer readmissions at 180 days after discharge.

Can doctors speak to family members without permission?

Technically speaking, patient privacy laws require patients to agree to the inclusion of a family member in these discussions, or the patient must name the family member in an Advance Directive. However, I have personally found that doctors, nurses, and other staff members often willingly speak with close family members without formal agreements.

Make sure you know how to handle home care tasks!

One of my most important tips for hospital discharges is to make sure you will be able to handle everything required once you get home.

After discharge, you may have to perform home care tasks that seem complicated and/or are new to you. It can feel scary, overwhelming, and confusing. But it’s important that you learn how handle the care needed for yourself or a loved one.

Therefore, work with the discharge planning manager to make sure you fully understand, and practice, all required tasks. And ask for written instructions and for links to educational videos for helpful tips and reminders.

What kinds of tasks might be involved? Home care tasks may include:

• Keeping wounds sterile and safe.
• Administering medications, including injections.
• Using a feeding tube, catheter, ventilator, or other medical device.
• Moving, bathing and toileting a loved one with limited mobility.

For more information, read How To Care for Someone Who Is Bedridden at Home.

Don’t think it’s the right time for discharge? 

You may find yourself in a situation where you think it’s too early for yourself or your loved one to go home. Perhaps you can’t arrange for timely delivery of necessary medical equipment, or perhaps you need additional time to hire home healthcare aides or to pick up prescription medications. Or you may fear that you or your loved one is too sick to be safe at home. Whatever the reasons for your concerns, it’s important to speak up as soon as possible.

Consider these options:

• Talk to the doctor and discharge planner if you think it’s impossible to have a “safe discharge”. Provide details about your concerns, in writing if possible.
• Ask your doctor to advocate on your behalf. Sometimes hospitals and health insurers pressure doctors to arrange quick discharges – having your doctor on your side may help.
• Tell the hospital Risk Manager why you are unhappy with the discharge plan.
• For hospital patients – ask to speak to the hospital ombudsman or someone from the patient advocacy department. However, realize they are hospital employees and may be loyal to the hospital.
• For patients in rehabilitation facilities – ask for the contact information for the ombudsman representative for the facility. Or find the ombudsman office for your state here.
• Hire a private health advocate. Although the services may be costly, their help can be invaluable. Learn more by reading How Can a Health Advocate Help You? 
• If the patient is covered by Medicare or by a Medicare managed care plan, you can file an appeal about a proposed discharge while you are still in the hospital. Ask the hospital for the form titled “An Important Message from Medicare” which explains how to appeal a hospital discharge decision. Appeals are free and generally resolved in 2 – 3 days. Importantly, the hospital cannot discharge the patient until the appeal is completed.
• If the patient will receive hospice services at home upon discharge, ask the hospice provider to call the hospital on your behalf. The hospice may intercede on your behalf, particularly if they will not be able to provide the needed services and equipment at the proposed discharge date.
• File a formal complaint with your state’s Department of Public Health (DPH). Find your DPH by searching online for {your state name} and Department of Public Health.

Tips for hospital discharges – reduce your risk of complications and readmissions.

Firstly, whether you are the patient or a family caregiver, it’s important to stay involved in the discharge process. As mentioned above, participate in the planning process, ask questions, learn required care tasks, and speak up as needed. Make sure you have a clear diagnosis, as well as a plan for what is required at home, including medications and medical equipment. And make sure you know what follow-up appointments will be needed and how to schedule them.

Fortunately, you can reduce the risk of post-discharge issues by following these tips for hospital discharges:

Before a hospital admission for yourself or a loved one, do some research:

• Hospitals need adequate nursing staff to cover all patients, during their stay and while preparing for discharge. One study found that hospitals with higher nursing staff levels significantly reduced their risk of Medicare and Medicaid penalties associated with excessive readmissions. If the hospital admission is not an emergency, research hospitals in your area before the patient is admitted. Find helpful links for research in the Zaggo Resource Center.
• Additionally, read these blog posts to learn more about choosing a hospital:
  • How to Choose a Hospital.
  • How to Choose a Hospital for Cancer Treatment.

Throughout a hospital stay, make sure you understand what medical staff tell you:

• If you don’t understand, ask for a repeat or rephrasing of the information.
• If you need a language interpreter, ask for one. Hospitals and doctors are legally required to provide interpretation services.
• Patients and families should use a notebook to take notes and a file to keep documents organized. Keep records regarding visits from medical professionals, tests and corresponding results, medications prescribed and other pertinent information. Share this information with every medical professional caring for the patient after discharge.
• Ask your doctors, nurses and/or discharge planner if you can record the discharge conversations so you can listen at home as often as needed.

Prepare for at home care:

• Review all written instructions and make sure you understand everything. Ask as many questions as you need until you feel certain you understand everything. And pay attention to details – for instance, if the paperwork says to call with excessive bleeding, ask how you can judge how much blood is too much.
• Ask what symptoms would require an office visit, and what would require a trip to the Emergency Department.
• Find out who is overseeing the patient’s care and who to call if an issue arises. If possible, get cell phone numbers – but use these numbers sparingly!
• Be sure you have a complete list of medications and understand when, how and why to take each one. Work with the nurse and discharge team to work out a system for organizing and remembering to take all medications. Medication errors upon discharge are very common – read 10 Tips for Avoiding Medication Issues After a Hospital Stay to learn more.

Equipment and medical tasks considerations: 

• Delivery of all medical equipment, including a hospital bed if needed, should take place before the patient leaves the hospital.
• Make sure everyone involved (the patient and/or family members) understands how to operate needed medical equipment. Find out who to call if you have questions or concerns regarding medical equipment if issues arise.
• For a safe transition, the patient and/or a family member must understand all required medical tasks (injections, wound care, etc.). For complicated or overwhelming tasks, practice in the hospital under the supervision of a nurse.

Financial concerns:

• If the costs of medications and/or equipment will stop you from following doctors’ orders, speak up. Don’t let embarrassment keep you from addressing a financial hurdle.

Considerations for follow-up care:

• Ask about how to follow up on pending test results. Find out when you, and your primary care doctor, will be notified with results. Record the date to call if you have not heard back – and get the exact phone number to call. Research shows that follow up on test results for hospitalized patients only occurs between 20% – 61% of the time.
• Ask about the hospital’s protocol for post-discharge check in calls. A hospital staff member should call patients and families within 2-3 days of discharge. Staff should use these calls to follow up on health issues, ask about follow up care, and to answer questions.
• Insist the hospital-based doctors reach out to the patient’s Primary Care Physician (PCP) to notify them about the patient’s hospitalization. PCPs need to know what treatments the patient received, and what follow up care is needed. One study found that 30% of PCPs were unaware that a patient of theirs had been hospitalized. Patients whose PCP did not know about their hospitalization were twice as likely to report a problem (31% PCP aware vs. 67% PCP not aware).

When you get home:

• Make any appointments for follow up care as recommended.
• Follow up with your primary care doctor to make sure he/she knows about the hospitalization.
• Fill all prescriptions and set up systems to organize and remember to take each medication. Realize that over 50% of Americans do not take their prescription medications as prescribed, which can lead to serious health consequences. To learn more, read Reduce Your Risk of Medication Errors.
• Call the doctor’s office to get any test results that you have not heard about by the expected date.
• Do not hesitate to call the doctor if a problem arises – it is best to catch an issue before it gets serious.

Don’t forget the emotional stress associated with hospital discharge.

Importantly, realize that the transition home can be scary for patients and families. In addition to all the tips for hospital discharges discussed above, a hospital stay for a serious medical condition can leave patients and families worried about what the future will bring. For one patient’s perspective, Read TheBody.com article How to Deal With the Anxiety of Going From Hospital to Home.

NOTE: I updated this post on 2-10-23.