How to preform a good discharge
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HOW TO PREFORM A GOOD DISCHARGE. Jason Haag Intern Conference. Before Discharge. Plan ahead Use Resident Assistants to Make follow up appointments On WebCis f/u lists Fax discharge summaries/patient information. Before Discharge. Plan ahead Talk to your patient

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How to preform a good discharge l.jpg

HOW TO PREFORM A GOOD DISCHARGE

Jason Haag

Intern Conference


Before discharge l.jpg
Before Discharge

  • Plan ahead

    • Use Resident Assistants to

      • Make follow up appointments

        • On WebCis f/u lists

      • Fax discharge summaries/patient information


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Before Discharge

  • Plan ahead

    • Talk to your patient

      • How do they pay for meds?

      • Who is going to pick them out?

      • How long will the hospital stay be?

      • Who do they live with at home?

      • Do they have home health/home PT already in place?


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Before Discharge

  • Start your discharge summary

    • Can put in procedures

    • Secondary diagnosis

    • Follow up appointments

    • Pertinent labs

    • Start the hospital course


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Discharge Day

  • Brief Discharge Summary

    • Most important take home message to patients

      • Diagnosis

        • what you have/had done

      • Medications

        • ***reconciled with home list***

      • Discharge instructions

        • What to do/what to look out for

      • Follow up appointments

        • Does not have to be exact date


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Discharge Day

  • Talk with Social Worker

    • Be very nice to these people…

    • About

      • Ride

        • They can provide one (ambulance, taxi, bus)

      • Medications

        • They can help pay for them (pharm assistance)

      • Home Health/Home PT

        • They can arrange it


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Discharge Day

  • Talk with the Nurses

    • Keep them in the loop

    • Nurses will provide

      • Patient education

        • How do I administer lovenox, do accuchecks?

      • They will decipher your discharge summary into patient talk

        • Make sure they understand what’s going on with the patient


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Discharge Day

  • Talk with Home Infusion

    • Talk early and often

    • They provide home IV therapy

      • Can arrange IV therapy on Saturday

      • Can arrange acute changes in antibiotic choice

        • IF they know about the patient ahead of time


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Discharge Day

  • Communicate with PCP

    • Don’t have to call

    • Send phone message with dx/tx

      • Not a novel (they can read your d/c summary), just give them a heads up


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Discharge Day

  • TALK WITH THE PATIENT!!!!!!!!!

    • They will have questions that they want their doctor to answer

    • The more time you put in early in the day answering questions will save you later


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Discharge Summary

  • Key Points

    • Carry over all diagnosis

    • Reconcile medication list

    • Procedures/imaging

      • No need to list every CXR, KUB

    • Pertinent Labs

      • Admission Chem-10, CBC

      • Special labs


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Discharge Summary

  • Hospital Course

    • List by problems

      • Overview of hospitalization

        • Not on HD#1…then on HD#2…

    • Express the maximum amount of information in the minimum amount of space

    • Be clear, concise, and coherent

      • The longer it is, the less likely someone is to read it


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Discharge Summary

  • Must do Brief Discharge Summary

  • To dictate or not to dictate

    • +/- of dictation

  • If you start falling behind

    • They will find you…

    • Medical Records keeps a log of physician of record and will track you down for delinquent d/c summaries

      • If you are too delinquent they won’t let you work (i.e. won’t pay you) till your caught up