From Hospital to Home – Help with Healing
By Wendy Benson
The hospital discharge process can be a stressful time for patients and their caregivers. I often relate it to getting ready step off a ledge: you’re not sure how high that first drop is, so it’s difficult to understand how things will go once you step forward.
Though patients are often relieved to be heading home, they are likely trepidatious. Hospitals are trying to do more and more to support patients when they are leaving the hospital, and we as healthcare providers are in a unique position to build patients’ confidence as they head home to continue their recovery.
Patients are sent home with discharge papers that typically outline the key information areas: medications, wound care; warning signs of complications; restrictions and medical care follow-up instructions.
What these documents don’t always cover are the ‘what ifs’: What if the pharmacy is closed by the time they get home? And if the patient’s “home” pharmacy is open, what if they don’t have the capability to compound the necessary medication? What if something happens outside of the typical physician office time – who does the patient call with questions?
In working with clients being discharged from the hospital, in my experience, those patients (and subsequently, their healthcare providers) benefit the most when the healthcare teams:
- Send and/or discuss discharge instructions ahead of time, well before surgery. Patients can consider questions and clarifications they might need in advance, even before surgery, and ultimately better prepare themselves and their caregivers.
- Determine additional equipment or accommodations as early as possible. Homes present very different environments when patients are recovering from a surgery or injury. Considerations such as flooring, door width and stairs are all potential hazards. I recall one client who, upon discharge, had declined an elevated toilet from the hospital. Shortly after returning home, this client quickly realized why that accommodation was offered. He may have accepted the offer immediately, and avoided a few hours of stress, had he talked about that with their surgical team ahead of time.
- Discuss existing medication protocol. New medications are generally indicated in discharge instructions, but the patient may not remember to ask about the medications that they routinely take. If they had stopped taking their blood thinner ahead of surgery, for example, when should they resume? And is there a right or wrong way to reintroduce any of these medications?
- Closely define physical restrictions. When patients are told to ‘take it easy’ the first few days after hospitalization, their interpretation varies. Some may be fine with staying in bed or lying on the couch for a few days. Others will push themselves until their body objects. One client who was released from the hospital after an injury, was told he should ‘slowly ramp back up.’ His interpretation was to continue to play sports (just not full contact), only to reinjure himself. Detailed examples of what is allowed, and what is restricted, will leave less room for misinterpretation.
- Include clear ‘next steps’ upon discharge, including specific contact information. Above all else,thosepatients who are discharged with clear next steps, including a specific person/office to contact with any questions, leave with increased confidence. Other next steps should include instructions on when to follow up with their surgeon; expectations of the healing process (i.e., if swelling is expected, how much can be expected, and at what point should they alert someone?) and how to involve their primary care team.
When discharging patients from the hospital, we as healthcare professionals understand the varying degrees of apprehension our patients are experiencing. However, with additional guidance and refined parameters, we can reduce this apprehension and anxiety – and create a more confident patient experience.