How to Have a Smooth Hospital Discharge

At some point, many of us will be admitted to the hospital. It can be frightening if you have never been a patient. And as ill-prepared we may be to be a patient, we may find we are even less prepared with our needs once discharged. Hospital stays have gotten shorter and shorter for many reasons, and often patients are not ready for their discharge, particularly if it was a complicated hospital stay and if more than one provider saw them. The hospital's goal is to discharge you as quickly as possible, even when you don't think you are ready. And sometimes,
 you may not know until late in the day that they are planning to send you home. So let's get you prepared to make it as smooth as possible.

Your discharge instructions will include the medications you will be taking after you go home, some of which may be new, or your dosages may have changed. Frequently your provider may send your prescription electronically to your pharmacy, but this method may be fraught with potential problems. We see shortages of certain medications, and when you attempt to pick them up, you may find them unavailable. Or, if you are discharged late in the day, your pharmacy may be closed, and you may not be able to get your medication. Be sure to let your provider know that you prefer to go home with all of your medicines pre-filled (they may be able to have them delivered from the hospital pharmacy). Either the nurse or you must confirm that they are in stock, covered by your insurance company, and able to be picked up that day.

Also, instructions are reviewed with you (typically, this is done by the nurse), and you have to sign that you understand. Be sure to ask what medications you will have received before you leave. For example, if you take a medication three times a day and leave at 2 pm, how many doses did you receive that day? You don't want to be underdosed or overdosed. If the medication is due around the time you will be discharged, ask if you can stay until you receive it (unless you are in the hospital for a 23-hour stay); you can wait until 11:59 pm! Confirm the dosage if your medications have changed, and don't be afraid to ask why.

Another part of the discharge instructions includes follow-up appointments. Often, you are instructed to make your own appointments. I had a stroke client who by the neurologist that he was to have a follow-up appointment with the doctor one week later. He called (as instructed) to make the appointment and was given a date three weeks out because the doctor had no openings. The doctor was unaware of his schedule and didn't tell his office staff that he needed to see my client. (FYI-the provider usually has no idea what the front desk is telling patients, and the job of the front desk is to protect the provider from being over scheduled.) To avoid this potential dilemma, ask if the appointment can be made before you are discharged. It's best to have your appointments sorted out before you leave. If this is not possible, relay to the receptionist that the doctor has asked to see you next week following your hospital stay. If you are given pushback, ask to get a message to the doctor or to his nurse or mid-level.  Be sure when the nurse reviews your instructions that you have someone else with you to ask the questions that you may have forgotten to ask and to be sure that you fully understand your next steps. If you have an advocate, email the instructions to them before signing them in case they have additional questions.

 
Remember, once you leave the hospital, it may be challenging to reach the doctors (or mid-level
Practitioners that took care of you), so get it all done before going home.

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