(Condensed from an article by Leonard J. Hoenig, MD in the June 2, 2006 issue of Medical Economics.)
1. Following an angioplasty and stent placement, an elderly man is discharged. Vital signs were stable, but his standing blood pressure was not checked. After arriving home he felt lightheaded, passed out, fell and fractured his hip.
2. An elderly woman was discharged after endoscopy for GI bleeding. After discharge, her daughter noted that she seemed less alert and less responsive than usual. She was readmitted with pneumonia and respiratory failure.
3. Another elderly woman underwent embolectomy for an arterial embolism on her hand and spent most of her stay in bed. The day after discharge, a visiting nursed found ulcers on her heels.
In all three cases, the patients were not examined by a physician on the day of discharge. Orders had been written the night before to "discharge in A,M. if vitals stable".
Discharging patients from the hospital may seem simple, but it is often not. Performing discharges correctly (including education of the patient) takes time, energy and thought. Such a comprehensive approach is worth the effort to both minimize the risk of medical disasters and provide the valuable opportunity in helping patients make the often challenging transition from the hospital to home (or other institution).
Suggested checklist for discharge:
1. Comprehensive evaluation of the patient
2. Make sure that you are convinced the patient is stable
3. Check pending lab and diagnostic results
4. Consider possible harmful interactions between discharge medications
5. Clearly advise patients if they are on potentially hazardous medication.
6. Arrange home health care when indicated
7. Provide patients and physicians with written copies of diagnoses, procedures, prescriptions and recommendation.
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