The discharge process remains a major obstacle for healthcare leaders who want to improve outcomes and reduce readmissions, in large part because patients often don't understand the instructions. New research now suggests multiple strategies that could improve the process, including treating it more like the admissions process and dispensing medications at that point.
At teaching hospitals in particular, junior residents usually interview patients for hours, often sharing any information gleaned with senior residents and the physician in charge to develop a plan of care. During discharge, however, the process is typically far more rushed and often conducted by a doctor who's not familiar with the details of the patient's case, writes Dhruv Khullar, M.D., a resident physician at Massachusetts General Hospital and Harvard Medical School, in a post for The New York Times´ Well blog.
Most successful interventions, Khullar writes, incorporate the attention to detail found in the admissions process into the discharge process. For example, follow-up phone calls helped Madison, Wisconsin's William S. Middleton Memorial Veterans Hospital cut admissions 11 percent. Another potential solution is dispensing medications to patients ahead of discharge, according to a study published in Pediatrics. Discharging patients with medications in hand significantly lowered the odds of readmission, leading Boston University Medical Center to add medication dispensation to their discharge protocols, according to Pharmacy Times.
Another potential solution is a program that helps patients manage the discharge process at home, according to a poster presented at the National Council for Behavioral Health's annual conference. As part of the program, providers identify high-risk patients and implement discharge plans over a 30-day period after a "warm handoff," according to Healio. Providers implementing the program report readmission rates of 17 percent.
Hospital design may hold potential keys to improving discharge as well; since introducing a transitional care center on the first floor of its trauma tower, San Antonio's University Health System has reduced patients' time spent in bed after discharge, Healthcare Design reports, with a goal of sending 30 percent of discharge patients through the unit over the course of the year.