Tag Archives: discharge planning

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When Plans Go Wrong – Visiting Nurse Visits Aren’t Happening

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(To view the case of the original post, go to Case 1.)

Some strategies at the time of discharge can help prevent the missed visiting nurse visits that Susan experienced.  The discharge plan is usually at the very least verbally explained to the patient by the attending physician.  (Attending physician is the term to describe the doctor who actually admitted the person to the hospital and writes most of the orders for the patient during her stay.  Orders include diet, activity level, medications, testing, consultations with other specialist physicians and therapies.)  Often a nurse will give the patient their discharge instructions (plan) and go over it with them in more detail before they leave the hospital.  It is then that such issues, as whether the visiting nurse visits have been arranged or not & how to contact them should be clarified.  If there are questions, it is a lot easier for the nurse to resolve the issue than it will be for the patient to take care of them once they are home.  Bottom line – you as the patient need to know exactly what the plan is for your continued recovery and when various visits are to take place and by whom with contact information for those other care providers.  In certain instances you may need to schedule some of these and you need to know which and get them scheduled ASAP after you return home. 

I would also emphasize that after discharge a patient should set up a post-hospitalization visit with their physician as instructed in the discharge instructions.  In most instances that should be within 2 weeks, but depending on the reason for the hospitalization and the treatment, it could be a lot sooner.  Also, you should not hesitate to call your physician if you notice new or worsening symptoms.  Sometimes an evaluation of these can wait until your scheduled appointment, sometimes not.  Sometimes, these symptoms can be due to a life threatening complication so time is of the essence.  That’s why a call to your doctor can be so important.

So, what should you as a patient being discharged from the hospital do to assure a smooth transition home?

  • If possible, have a reliable relative or friend with you when you get your discharge instructions.  For most hospitalizations you will not be able to drive home by yourself, so the person picking you up can help with this.
  • Ask for a copy of your discharge instructions so you can look at them while they are being read to you.  Follow along and make notes on the paper.
  • Make sure that any questions you have get answered before you leave.
  • Make sure you understand what are your responsibilities once you get home, for example, when does the doctor want you to make an appointment to be seen in the office?
  • Make sure you know what other components of care you will be receiving and whether you need to contact anyone before those appointments begin.
  • Always get contact information for any of the other care providers who will be working with you.
  • VIP!  Make sure you know what medications you should be taking and whether the medications you were taking before admission should be stopped or continued.  I have heard of instances where a person was taking a brand name medication before admission and was discharged on the same drug but the hospital staff referred to it by its generic name.  When they got home the patient took both medications and had significant side effects from the double dose that required an emergency hospitalization.  Such mistakes can be fatal.

So with some preparation this issue Susan encountered might have been avoided.  In the next post I’ll discuss what to do to make sure your doctor calls you back.

For Your Health – Dr. Bob

When Plans Go Wrong – Discharge Plans

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The post, When Plans Go Wrong, shows why it’s important to learn how to use the health care system and be an advocate for yourself to safeguard your health.  (For your convenience you can find a copy of it under Cases To Consider.)  This post is all about Discharge Plans.

A word about Discharge Plans:  Transitions from one health care setting to another are always risky.  Whether it’s going into the hospital from home from the hospital back to home, mistakes in communication are more likely to happen.  To try to prevent these miscommunications from happening in the transition from hospital to home the attending physician, the doctor who cared for the patient in the hospital, gives the patient a Discharge Plan.  It is a written plan that tells the patient what medicines to take, what diet to eat, any limitations of activity, what tests they need to get and where they are to get them, any physical therapy they may need and from whom they should get it, any referrals to specialists they need to have, and finally, when the attending doctor wants to see the patient in their office.

When Plans Go Wrong outlines several issues that went wrong with the implementation of Susan’s discharge plan:

  1. Susan couldn’t get the medicine that worked for her in the hospital
  2. Home health nurse & home physical therapy visits weren’t happening
  3. Her physician hasn’t called back
  4. She is unable to get to her doctor visit

On the next posts I’ll talk about each of these issues from my perspective as a physician and patient. 

For Your Health – Dr. Bob