• E-mail
• Print
• RSS

Discharge planning

Patient Access Weekly Advisor, January 2, 2008

Want to receive articles like this one in your inbox? Subscribe to Patient Access Weekly Advisor!

What's actually keeping hospitals from early discharges?

According to Bud Pate, REHS, practice director for The Greeley Company, a division of HCPro, Inc., in Marblehead, MA, there are four main barriers that prevent hospitals from discharging patients earlier in the day.

Barrier one: Who's in charge?

Most hospitals are dealing with more complex patients who often see multiple physicians. A patient may enter the hospital through family medicine, but the hospital may later transfer him or her to cardiology, so now staff members must make a split decision-where does the discharge come from, and who makes the decision?

To help clarify, Smith said you must focus on what clinical issues you need to resolve prior to a patient's discharge. "What physician has the key to addressing these problems? This may change each day, so it is important to ask the question every day."

Barrier two: What tests do patients need?

Smith recommended that you identify possible discharges the day before and try to identify the controlling physician and what type of testing may be necessary.

"You also need to plan the sequencing of testing," said Smith. "Often, one test needs to follow the other. And if [you] don't plan out the sequence correctly, a patient can easily end up staying in the hospital an additional day."

Barrier three: What type of posthospital care?

What type of posthospital care do you require for the patient? This is a question that Smith said you should ask on the first day of a patient's admission and every day that the patient remains in the hospital. "If we're thinking ahead with the beginning in mind, postacute care should rarely be a concern," said Smith.

Barrier four: Will the physician make his or her rounds in the morning?

The last major barrier is a practical one. Is the physician around in the morning to examine the patient for a discharge? More often than ever, physicians are practicing at multiple locations and spreading care from the inpatient hospital to outpatient surgery centers and physician offices.

These logistics sometimes make it difficult to discharge patients. Under these circumstances, Smith said to be proactive and do the discharge work the day before the actual discharge.

Want to receive articles like this one in your inbox? Subscribe to Patient Access Weekly Advisor!

• Comment
• E-mail to a Colleague
• Print
• RSS
• Archive

Comments