The discharge process has now been recognized as one of the most crucial points at which the actions of doctors and hospitals can have a huge impact on immediate health outcomes for our patients. At a time when 30-day readmission rates are still touching almost 20 percent for Medicare patients (higher for certain patients, with up to a third of these occurring in the first 7 days), there is an increasingly urgent need to focus on this transition of care point. Discharging a patient is, by its very nature, a risky process. Patients are typically still not at their baseline, and their recovery hangs in the balance. As the main attending physician, the role of hospital doctors is pivotal in making discharges as flawless as possible.
Let’s go through how the typical hospital discharge works in the world of medicine. The doctor will see the patient and make the decision that they are well enough to leave the hospital. These discharge plans will often only be made clear at the last moment. The nurse may be taken by surprise as the doctor pops their head through another patient room to inform her of the great news: “Mr. Adams can go home, I’m discharging him.”
After a brisk discharge summary and the completion of the paperwork, the patient and their family will get a piece of paper given to them by their nurse. If it’s not written in ineligible writing (using medical jargon that most doctors’ own parents wouldn’t even understand) on a thin sheet of paper, they will get a printed piece of paper where the doctor has entered the information on a computer. In either case, the whole piece of paper will be less than appealing in appearance. It will contain the patient’s discharge diagnosis, medications (frequently with changes from the admission medications), and follow-up instructions. This is one aspect of the discharge that I’ve always wondered about, and has pretty much been overlooked in every hospital I’ve ever worked in: the design of the discharge paperwork. What am I talking about? Well let’s suppose you are asked to follow through on some very important instructions, would you be more likely to follow them if they were presented to you on a tatty piece of paper or well-presented in a more beautiful and eye-catching way?
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