Hurray! You are leaving the hospital. That’s cause for celebration. You are better, well enough to go home or at least to a nursing or rehab facility to continue your recuperation. But there are important things to know and do to help ensure smooth sailing in your recovery. You don’t want to backslide, and you surely don’t want to face the prospect of readmission to the hospital. Here are some Dos and Dont’s to help guide you.
- make sure you understand your discharge plan
- be certain that the plan is realistic for you and your family
- get copies of your medical records before you go
- make plans to follow up with your primary care physician as soon as possible
- ask someone you trust to visit nursing or rehab facilities in person
- leave the hospital without knowing what to do in an emergency
- agree to discharge if you feel you aren’t ready to leave
- be afraid to voice your fears or concerns about going home
- avoid discussing important restrictions such as diet, driving and sex
- assume that insurance or Medicare will cover all of your home expenses
One of the greatest causes of readmission to the hospital is patients not understanding their discharge plans. Sometimes these plans are written in shorthand summaries that leave lots of questions hanging. Sometimes they don’t make sense to patients. Make sure you go over all the details of the plan with a social worker, case manager or nurse. If instructions are not clear or are confusing, ask for clarification or further instruction. Be sure the plan makes sense to you and your family before you go.
It’s one thing to know what’s expected; it’s another to be sure it’s realistic. Are you supposed to get physical therapy twice a week or see your doctor a week after you get home? Can you drive yourself or is there someone who can take you? Do you need new medications or home devices such as a walker or potty chair? How will you get these items? Discussing these details with hospital staff and with your family or friends is an important part of your successful transition home.
Sometimes the hospital will provide you with a summary of your medical care as part of your discharge plan, but sometimes you have to ask for it. Some hospitals even make patients pay for copies of complete files. It is important to have as much of your medical record as possible for your own reference but also for follow up with your regular doctors who were not involved in your hospital care.
Most likely, your primary care physician will not be attending to your needs while in the hospital. You will probably be assigned to a hospitalist, a doctor who works for the hospital and manages patient care. But your hospitalist will not be involved once you leave the hospital, so it is critical that you follow up with your primary care physician and make sure he or she is up to date on your medical status.
Your doctor may recommend that you go to a nursing or rehab facility to continue your care before going home. This is often the case for patients who need special postoperative treatment, intensive physical or occupational therapy or other specialized care. Hospital social workers may recommend facilities, but make sure that someone you trust visits several places in person to find the one best suited to your likes and needs.
As part of your discharge planning, make sure you know if there are any warning signs you should be aware of, such as fever, redness or pain. You need to know what symptoms are normal and which are cause for concern. Before you leave the hospital, ask your doctor or nurse for advice so you know what to do in an emergency. For example, should you call the doctor or return to the hospital emergency room if warning signs appear?
Sometimes patients are prepared for discharge before they feel ready to go home. The first step is to talk to your doctor. If there is legitimate, medical cause for concern, it may require appealing the doctor’s decision. Patients covered by Medicare have an important appeal right involving the state Quality Improvement Organization listed on the Medicare form that is part of the admission process. If you aren’t on Medicare, then raise your concerns with the hospital’s medical director or administrator.
If you are afraid to go home for some reason or worried about taking care of yourself, you should discuss your concerns with a social worker, case manage or nurse before you leave the hospital. Older patients often have these fears and are worried about sharing them with family or friends. Giving voice to your concerns and, more importantly, developing a plan for dealing with them are important to your recovery.
Patients are sometimes hesitant to raise questions about restrictions, especially if they think they may not like the answers. Be sure you find out what you are allowed to eat, when you can resume normal activities such as driving and when you can have sex. These may be touchy topics, but it’s important that you understand the doctor’s instructions and are prepared to make accommodations that may be necessary.
If your follow-up care involves special treatment, such as intravenous drug therapy at home, your insurance or Medicare may not cover the costs which can mount quickly. Alternative arrangements may be possible, such as going to an infusion center. So be sure you discuss your needs and your coverage benefits with a social worker or case manager before agreeing to the discharge plan. You don’t need sticker shock on top of everything else.
Leaving the hospital is an important milestone whether you are going home or to another facility. It’s important to be sure that your discharge plan makes sense for you and your family, that your questions are answered before you go and that you feel prepared to take the next steps on your road to recovery. Don’t leave the hospital until your questions are answered and you feel confident and comfortable about your plans. Doctors, nurses, social workers and case managers can help you with your goals.