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See the Discharge Process Through the Patient's Eyes

Case Management Monthly, April 6, 2010

The most important people in a hospital are not the physicians, the nurses, or the executives; they are the patients. Taking the time to see the hospital through their eyes can do wonders for the facility, according to Greg Nelson, president of Baptist Leadership Group in Pensacola, FL.

"The overall focus here is moving from provider to patient centeredness," Nelson says.

Basic challenges at any facility include overcoming barriers to discharge, promoting physician buy-in, and increasing patient flow and throughput. In order to address these issues, you also must address the discharge process, says Nelson.

Shorter length of stay means harder discharge planning
The advent of the diagnosis-related group system gave hospitals an incentive to decrease the length of stay.

The average length of stay is two days shorter than it was 15 years, Nelson says. "We are trying now to get our patients home as soon as we can. I understand the financial reason for that, but we must understand the clinical implications," he says.

Stefani Daniels, RN, MSNA, ACM, CMAC, managing partner at Phoenix Medical Management, Inc., in Pompano Beach, FL, says financial implications are not the only reason to reduce length of stay. The acute care setting is a high-risk environment, and patients are safer in a lower level of care or at home. Regardless, the reduction in length of stay has made the discharge process critical. Patients and their families now change wound dressings, administer medications, and monitor progress.

"We expect patients to serve as their own little case managers," Daniels says. "And in most cases, it is unrealistic."

Staff members in every facility must reinforce the discharge plan, make sure that patients clearly understand the discharge instructions, and follow up with patients so they remember what their instructions are.

"Patients remember 10%–15% of the content of discharge instructions even when they are given a brochure and formal instruction," Nelson says.

Having dedicated staff members who contact patients within 48 hours of discharge to remind them of discharge instructions is a great way to ensure compliance with the discharge plan, say Daniels and Nelson.

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