Case Management

Mentor moment: Planning for discharge

Case Management Weekly, November 21, 2012

Discharge planners and other healthcare professionals are aware of patients’ rights to be involved in care planning. For this to occur, however, discharge planners must be aware of the available options from which patients may receive treatment. Patients sometimes request treatment not considered appropriate for their condition. In these situations, discharge planners should consult with patients’ physicians to counsel patients and determine why they requested the treatment.  

When a patient refuses treatment, discharge planners must exercise professional judgment to determine whether that decision poses a risk to the patient. For example, discharge planners must counsel patients who clearly need a referral for home health services but refuse it with risks of doing so. Discharge planners must work through matters such as this with the patient, family members, physicians, and any other healthcare professional involved in the patient’s care. Patients have the right to choose, but discharge planners must ensure that patients know the risk of their choice. Also, when hospitals have objective information indicating that a patient’s choice may not be appropriate, the patient and family members must receive this information.

 If a patient’s choice includes a level of service not appropriate for that patient’s assessed needs, as validated by the patient’s physician, documenting that fact is necessary. Discharge planners who think a provider chosen by the patient/family members has a poor reputation for quality service must validate this opinion objectively, usually through the quality assurance department. Failure to use a particular facility merely because of a perceived poor reputation may cause that facility to view that decision as an attempt to interfere with its ability to receive referrals. 

Remember, however, that unless patients are deemed incompetent, they have the right to request or refuse treatment. When patient competency is a concern, discharge planners should take appropriate steps to assess a patient’s competency level. Discharge planners should review hospital policy ad state requirements that address this topic. 

Editor’s note: This article is adapted from Discharge Planning Guide: Tools for Compliance, Third Edition published by HCPro, Inc.

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