Tips for Hospital Discharges

You might feel both happy and stressed when doctors decide you (or a loved one) can go home from the hospital. 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. The cause for concern is not unfounded. The transition from hospital to home can be hazardous for patients and caregivers. Although this post focuses on potential issues surrounding discharges from hospital stays, patients going home from rehabilitation facilities face similar issues. 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 are hospital discharges potentially dangerous?

Danger can occur when patients and/or family members do not understand how to care for themselves or their loved ones or are incapable of providing needed care. For instance, people can make medication errors, struggle with wound care, and miss important follow-up tests and appointments.

Shorter hospital stays can make care at home difficult.

Nowadays, hospitals discharge patients after shorter stays, which in general is a good thing since hospitals are full of dangerous germs that can make patients sicker. (To learn more, read How Can Patients Protect Themselves from Hospital Infections?)

But there’s a downside to shorter stays. Sending home sick patients with complicated medical needs that were historically handled by medical staff increases the risk of dangerous complications and infections – which can lead to serious health consequences and hospital readmissions.

What do patients and families want?

Researchers recently interviewed patients and family caregivers about their concerns around hospital discharges. The patients and family caregivers reported:

• A desire to feel prepared and capable of caring for themselves or a loved one at home.
• Wanting to know the healthcare system will meet their needs until they stabilize or recover
• A desire to feel cared for and cared about by medical providers.

The researchers then compared the impact on care transition strategies on patient health. Unsurprisingly, they found for the hospitals that worked to improve trust in hospitals, used plain language, and coordinated care, their patients were more like to report improvements in:

• Physical and mental health
• Sleep quality
• Ability to do daily activities
• Pain levels

Moreover, researchers found these patients were less likely to return to the hospital or emergency room. However, these patients were more likely to spend at least one day at another healthcare site in the 30 days after leaving the hospital.

Patients need understandable, effective discharge instructions.

Clearly, understanding discharge instructions helps you, or your loved one, recover and remain healthy. Therefore, hospital staff should make sure all parties understand exactly what care is required. Additionally, staff should be certain patients and/or family caregivers are willing and capable of performing the required tasks. Finally, staff should ask patients about their living arrangements to make sure patients will be safe and will receive the proper care. But hospitals often don’t do a good job preparing patients and families for discharge. In fact, federal data shows that less than 50% of patients feel confident in their understanding of how to care for themselves when they leave the hospital.

Furthermore, research shows that about 1 out of 6 Medicare patients are readmitted within 30 days of discharge. Researchers surmise that part of the reason for this high readmission rate is that hospital staff often rush patients and families through the discharge process.

For more information, read my blog posts:

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

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

You may find yourself in situation where you think it’s too early for you 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 but having your doctor on your side may help.
• Ask to speak with the hospital Risk Manager. Tell them 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 employees of the hospital 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.
• You can 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 be willing to intercede on your behalf, particularly if they will not be able to provide the needed services and equipment at the proposed discharge date.
• You can 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.

Fortunately, you can take steps to reduce the risk of post-discharge issues – before, during and after a hospital (or rehab facility) stay. My 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:
  • Does it Matter Which Hospital You Use? Yes!
  • Wondering How to Choose the “Best” Hospital? Find out How Doctors Would Choose a Hospital for Their Own Care.
  • How to Choose a Hospital for Cancer Treatment.

Throughout the 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.
• 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 Medication Errors Are Common at Hospital Discharge 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 the patient and/or family understands how to operate needed medical equipment.  Find out who to call if you have questions or concerns regarding medical equipment if issues arise.
• The patient and/or a family member must understand and practice medical tasks (injections, wound care, etc.) required.

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 follow up on 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 of the medical issues 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 2-1-21.