Discharge, Adios, Goodbye, Thank you for seeing me, Take care of yourself: No matter how you say it healthcare providers need to do a better job when the patient leaves their site by Tamala 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 some 5 take-aways 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)      Since we no longer work in silos, 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 patient care that leads 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 http://www.teachbacktraining.org/ and http://www.ihi.org/resources/Pages/Tools/AlwaysUseTeachBack!.aspx

For more information about motivational interviewing, visit http://www.motivationalinterview.org  or http://www.ncbi.nlm.nih.gov/books/NBK64964/

For more information about discharge phone calls, visit https://www.studergroup.com/what-we-do/institutes/upcoming-institutes/taking-you-and-your-organization-to-the-next-level/taking-you-and-your-organization-to-the-next-l-(2)/tyyo-post-event-page/temp_tools/post-visit-phone-calls/ or http://www.ahrq.gov/professionals/systems/hospital/red/checklist.html

Side note:  I do not have any financial interest in any of the items mentioned in this blog.