A Hospitalist’s Responsibility in the Discharge Process

With the arrival of the vaccine against SARS-CoV-2, there is global optimism. However, with a continued influx of sick patients and health care facilities taking a toll from it, COVID-19 still poses significant clinical challenges.

Throughout the COVID-19 pandemic, it has become critical for hospitals to have enough available beds. A relentless rise in hospitalizations due to the pandemic has made this difficult and has hurt many health care system areas. From postponing elective procedures to reducing admittance of non-essential care, health facilities are stretched beyond their limits and hurting from it. The cancellation of surgical cases paired with high costs for COVID-19 care, and the drop in non-COVID-related ambulatory care have all contributed to steep hospital revenue reductions.

As hospitals continue to bring back volume safely, a smooth and efficient discharge process is crucial to improve patient flow and lessen the need for rehospitalizations. Experts agree that a successful handoff is paramount in preventing avoidable readmissions.

However, factors that influence readmissions are often nonmedical, including:

• Home environment
• Health literacy
• Adherence to prescribed medications
• Ability to keep up with follow-up appointments

So, what does this mean for hospitalists?  

Hospitalists are responsible for ensuring that patients understand their condition, treatment plan, what to watch for, and who to call in a crisis. They play a crucial role in taking care of these transitions and follow-up, even with the above non-medical influences on readmission.

Here are a few key ways to make the discharge process a smooth and timely experience for you and your patients.

Ask the right questions, and then identify the solutions.

Taking a step back and identifying the specific variables that stand in the way of a safe discharge is an essential first step. Ask questions like:

• Why is the patient here?
• Why is the patient still here?
• What has changed, allowing the patient to go home?
• When will the patient be discharged, and where are they going?

Through answers to these questions, hospitalists may be able to identify if patients are well enough to leave and any potential barriers that stand in the way of them doing so. The team can then discuss which patients are ready and create a list of what is needed for their discharge.

Be proactive and accelerate communication.

A lapse in communication can often be traced as the main culprit of a fragmented discharge process. When a patient can be medically identified for discharge, hospitalists need to escalate the directives required to move forward. Instead of waiting for validations from a consultant, actively reach out to them. Additionally, keep the full team in the loop. Utilize cross-functional communication tools, such as a whiteboard, and leave notes that the team can access during different shifts. Visual reminders are a great tool for prioritizing tasks and the need to focus on patient discharge.

Take accountability for the post-discharge process.

After discharge, hospitalists continue to take care of the patient – but in a different way. It’s important to remember that team members are accountable for what happens next. Follow up on pending lab results. Make a post-discharge phone call. Make yourself reachable by phone.

Key ways to better prepare your patient for a smooth transition may include:

• Communicating essential information to the patient and their family.
• Offering a contact for questions that may arise after discharge.
• Promptly communicating with the primary care physician.
• Helping patients make and keep timely follow-up medical appointments.
• Reconciling the patient’s medication schedules.
• Assessing those at greater risk of post-discharge problems or readmissions.

Ultimately, a good discharge experience can be linked to good communication. A lack thereof is a problem and leads to readmissions. As hospitalists, the part we own is communication. When we can commit to not only turning around beds but setting up patients for a successful transition home, we’ll see our health systems significantly improve.

Contact Advanced Care Hospitalists to Learn More

ACH is a Lakeland-based hospitalist group providing comprehensive patient care in community hospitals across Central Florida. If you are interested in learning more about our programs, services, providers or becoming a partner facility, please call us at 863-816-5884 or fill out a contact form online.