Discharge planning is fraught with pitfalls for hospitals, according to a new report, but effective communication and adaptability can help providers avoid them.
The United Hospital Fund, a New York-based nonprofit aimed at improving the healthcare system, interviewed frontline staff and administrators at eight hospitals in the New York City metropolitan area to paint a better picture of the challenges they face in determining the best post-acute care options.
One major problem, according to the report, is that a patients’ status is often rapidly changing, and that means the discharge plan must adapt, too.
Joan Guzik, director of quality improvement for UHF’s Quality Institute and one of the report’s authors, told FierceHealthcare that this issue can be compounded by pressure on the clinical team to treat and discharge patients quickly and efficiently.
“Even if it is a short length of stay, the actual, best plan and best setting for their discharge might not be known,” Guzik said.
This may mean establishing more than one potential post-acute care plan at intake, and then adapting to changes in the patient's condition to fit their specific needs, according to the report.
Regulations aimed at boosting patient choice may also make providers feel as though they can’t make recommendations for skilled nursing facilities or other post-acute care options, even though patients often ask for this insight, according to the report. The information patients are given is often in a printed list and doesn’t typically break out quality scores or other data that’s useful in choosing a post-acute care facility. In some cases, the patient or a caregiver is told to visit and tour facilities themselves, but in a tight discharge timeline that is often not feasible, according to the report, and they may not be clear on warning signs to look for in a nursing home tour.
Patients can be directed to access ratings online from the Centers for Medicare & Medicaid Services through Nursing Home Compare, but they rarely do so, UHF found. This poses a particular challenge when the patient may not speak English, Pooja Kothari, R.N., program manager for UHF and the report’s other author, told FierceHealthcare.
“Patients who have low health literacy skills or do not speak English are not as comfortable doing research online and are also particularly needing of particular information and support,” Kothari said.
Kothari said that some providers are relatively unfamiliar with Nursing Home Compare, and that they may struggle to contextualize what the ratings mean to patients, which could pose another communication challenge. In addition, quality data available may not speak to the individual concerns that patients and their families have, Guzik said.
“There is quality information available publicly, but that may not necessarily be information that is really what patients and families want to learn,” she said.