When Is It Safe To Discharge A Patient From The Hospital?
When I initiate final hospital discharge planning, I am making a clinical judgment that the patient is safe to leave the monitored confines of the hospital system. Hospital discharge planning begins on the day of admission.
Good hospitalists are always thinking in their minds how to get the patient safely discharged in the quickest, safest and most efficient way possible.
Sometimes the patient wishes to leave against the medical advice of the physician. Sometimes they refuse to leave at the advice of the physician. And sometimes the physician and patient agree it’s time for the next level of care.
But how do you as a physician know to pull the trigger and initiate the final hospital discharge planning process in a manner consistent with quality care? How do you know when it’s safe to write the order for discharge? A certain number of my patients will always bounce back into the hospital. The frequent flyer club is alive and real. Whether it’s the natural progression of endstage disease or issues with medical compliance or access issues which result in readmission, it doesn’t really matter. The best way to prevent preventable readmissions is to have system processes in place that maximize success with the hospital discharge planning process.
So I have to ask the question: Is there a defining patient characteristic which guarantees safe discharge from the hospital and guarantees complete immunity from prosecution should a bad outcome occur?
That answer is yes. Here’s a text I got from Happy’s nurse coordinator on the scene of the crime:
Happy, the nurses told me your abdominal pain patient in room 503 was having sex last night. They walked in on her. Do you think it’s safe to discharge her this morning?
The answer to that question would be a resounding yes. If you’re well enough to have sex in the hospital, you’re well enough to have hospital discharge planning initiated immediately. Looking down the road, I think the patient’s actions opened up the hospital to liability. I wonder if this patient will sue the hospital for pregnancy related complications due to ongoing alcohol and tobacco abuse. It would appear to me that getting pregnant in the hospital would be considered a hospital acquired never event. No patient should ever get pregnant in the hospital. Perhaps this will require a smack down by the Joint Commission on par with the crime of the century of not dating and signing verbal orders within 24 hours.
If your patient is having sex in the hospital, you can mark my word, hospital discharge planning should be initiated immediately.
*This blog post was originally published at The Happy Hospitalist*
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