Many hospitals, including the one where I am the medical director, have worked hard to improve the discharge process. But despite our efforts, our patients and families consistently rate it as one of the least satisfactory aspects of their hospital experience. In an attempt to reduce the number of patients who are readmitted to the hospital less than 30 days after they leave, Medicare and other insurers have focused on this process, and next year will begin penalizing hospitals if a patient returns.
THE 5 THINGS YOU MUST KNOW
Medicare has created "Your Discharge Planning Checklist" (PDF). This six-page document lists 22 different areas to cover with your doctor and health care team. In an ideal world, medical professionals would help you go over all of these points. But, in the excitement of getting to go home, few of us are likely to make it through the whole list. Here's my top five.
MEDICATIONS: It seems obvious, but this is the greatest source of confusion. You have the medicines at home that you were taking before you came to the hospital. When you checked into the hospital, these same medicines may have been changed to a generic or another equivalent medication that was substituted for the one you took at home. You may not be aware that the new prescription that the doctor gives you at discharge is really the same medicine you've been taking before. This may put you at risk to take a harmful double dose. You need to have your nurse or doctor carefully go over your old and new list to make sure everyone is on the same page. Another tip: Only use one pharmacy, so that the pharmacist will have a record of all your medicines and can identify any potential problems. Have the hospital or pharmacy fax your final list of medications to your primary doctor. So often the doctor who takes care of you in the hospital is not the doctor who will follow you once you go home.
RED FLAGS: When you are in the hospital, help is only a call buzzer away. Spike a fever and a nurse will draw your blood. Cough up something green and you will get a chest x-ray. But, once you are home, it is hard to know what warrants a call to the doctor. Don't settle for the computer-generated form that the hospital hands out to patients. Ask your doctor for your specific condition's red flags. How much pain is too much pain? How long will it continue to hurt when you urinate? How much longer will I be coughing? Is there anything special that should make me run to the hospital, rather than call my doctor?
WHO TO CALL: Get the specific phone numbers of who to call if there is a problem. My wife had surgery on a Friday, so I asked the doctor for the name of who would be on call that weekend, and if he would let them know that we were out there. Make sure that someone at the hospital you are leaving lets your primary care doctor know that you are loose on the street. I always give patients a copy of their entire lab and x-ray reports to carry back to their main doctor. If they get into trouble before a scheduled appointment, then they have the critical information with them.