The world of health care has made tremendous progress in the last several years in raising the quality and safety of clinical medicine. Yet despite this, the discharge process (when patients are discharged from hospital) is still fraught with potential pitfalls and opportunities for things to “slip through the net.”
If you ask most patients who are discharged—particularly the elderly with multiple medical problems—they will tell you that the process often appears rushed and haphazard, with many things still unclear to them when they exit the hospital. A central problem rests with time itself. For a thorough discharge to occur, the physician needs to spend a lot of time methodically going over all aspects of the hospitalization, working out the appropriate discharge medications and then clarifying the necessary follow-up. This can sometimes take over an hour per patient and in reality this time simply doesn't exist in the busy world of hospital medicine (and doesn't in any health care system or country I'm aware of). Doctors and nurses therefore need to focus on the most pertinent points.
Having said that, there are also some things that patients can always do to greatly reduce their chances of post-discharge complications or an abrupt readmission. Here are 3 of them:
1. Don't leave the hospital without feeling comfortable about your medication list and clarifying every single one.
During any hospitalization, many home medications can be stopped or changed. Common examples include blood pressure and diabetes medications that will be adjusted in response to fluctuations in these parameters during illness. In addition there will be new medications prescribed upon discharge. Elderly patients, who form the bulk of hospital admissions, can be on a dozen or more medications, and it is imperative to go over the complete medication list and understand what needs to be taken and what doesn't. It may also be a good idea to have a family member present at this time as well. If this has not been explained thoroughly, be sure to ask the doctor or nurse to confirm before you leave the hospital.
2. Quick follow-up with your primary care doctor.
It's always a great idea to quickly follow-up (within 5-7 days) with your primary care doctor. Medical studies may have shown mixed results regarding the efficacy of doing this, but it's basic common sense that this would be a useful thing to do after any complicated hospital admission. Let your doctor go over the details of your hospitalization, medication list, and whether you are still in good shape. Potential problems can be nipped in the bud and any confusion with your medicines can be clarified. Nearly all primary care offices will reserve slots for their patients who've just been discharged from hospital.
3. Monitor yourself like a hawk.
Remember that most people who leave hospital are still in a somewhat fragile state of health. The hospital has done its job in getting you on the path of recovery, but there's still some way to go. If within the first few days after leaving the hospital you start to go in the wrong direction, don't wait—seek help immediately. Never has the phrase a stitch in time saves 9 been more appropriate. Examples include someone with congestive heart failure noticing increased leg swelling, or someone with chronic bronchitis noticing they are more short of breath again. You only have a small window from developing any of these symptoms to going past the point of no return and needing a hospital admission. Get help early on when you need it.
Although the whole discharge process is significantly better than it used to be a few years ago, we still have a lot of work to do. Many patients are still in 50/50 health when they leave the hospital and there's no way to guarantee a successful outcome. But some basic and common sense rules should always be followed. Physicians often forget that nobody wants to get better and have a successful discharge more than the patient themselves. Education on points such as the above and putting patients in charge of their own care can work wonders in preventing complications and readmissions.
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.