When people have recovered sufficiently or can be appropriately treated elsewhere, they are discharged from the hospital.
To determine when people should be discharged, the doctor weighs the risk of developing a problem due to being in the hospital (such as getting an infection) against the benefits of being treated in the hospital.
If people can be appropriately treated outside the hospital, it is usually better for them to be at home, even if the illness that brought them to the hospital has not yet completely resolved.
People can complete their treatment outside of the hospital if
They are able to take food, water, and medications by mouth.
They can obtain the prescribed medications.
Their pain is reduced to tolerable levels (but not necessarily completely relieved) by medications.
They can move around their residence and care for themselves or have the help needed to do so.
Their condition no longer requires advanced daily monitoring with hospital equipment.
Follow-up appointments with their doctors have been arranged.
Before discharge from the hospital, staff members may evaluate people's ability to move around safely and ask questions to determine whether they are likely to need extra help after discharge. A discharge planner or a social worker at the hospital can anticipate which problems are likely, then make suggestions about and arrange for needed home health care services, which may include a visiting nurse, a visiting physical therapist, and equipment, such as a wheelchair or shower bench. However, people and their family members should be involved in these plans to make sure they are appropriate.
If further care is needed temporarily or permanently after a hospital stay, people are often sent to another facility. They may go to a rehabilitation facility or a nursing home (skilled nursing facility).
Before leaving the hospital, people or their family members should make sure that they receive detailed instructions for follow-up care and that they understand the instructions. They should get a written schedule for using all their medications and for follow-up appointments. Unless arranged before discharge, upon arriving home, they should call their regular doctor to make a follow-up appointment. Telling the doctor's nurse or scheduler that they were just discharged from the hospital and that they need an appointment within the next 3 to 10 days is important to assure that they receive appropriate follow-up care.
If people are being discharged to another facility, a written summary of their hospital evaluation and treatment plan (called a transition care record) should be sent with them and another copy faxed or transmitted to the facility.
Regardless of whether people are being discharged to another facility or are going home, they should be given written paperwork that includes the following:
The reason for the hospitalization
Major procedures or tests done
The main diagnosis at discharge
Any recommended dietary restrictions or modifications
Any restrictions on activity (such as walking, exercising, or driving) or movement
The need for assistive devices, such as a wheelchair, a walker, crutches, a CPAP (continuous positive airway pressure) machine, or oxygen
Instructions for care of any surgical incisions or wounds
If applicable, instructions for how and when to measure their temperature, blood pressure, blood sugar, or weight after hospital discharge
A list of any symptoms that require them to contact their doctor or return to the emergency department
Dates and times of follow-up appointments with their doctors
A list of current medications, including what doses should be taken, how many times a day the doses are taken, and how long the medications should be taken
Hospital staff should review with the person being discharged any changes in previous medications or any new medications that have been started. People should also request that their attending physician inform their regular doctor about their care while they were in the hospital, when possible in written form (called a discharge summary) and/or by a telephone conversation.
Sometimes after people are discharged, their condition worsens, and they have to return to the hospital for additional care.
Obtaining medications
Most people are given prescriptions for new medications when they are discharged from the hospital. Sometimes people have trouble obtaining these medications. For example, their preferred pharmacy may not stock the medication, or their insurance may not cover the costs and they cannot afford the medications.
Sometimes people get their medications through a mail-order pharmacy, and it takes several days or a week to get the medications. This delay can be dangerous because some medications (such as antibiotics or anticoagulants, which prevent blood from clotting) must be started or continued immediately after discharge, and to prevent serious complications, people must not miss a dose. To avoid any delay, people should ask their doctor to electronically submit or fax the prescription to a local pharmacy, and they should call the pharmacy before leaving the hospital to verify that they can obtain the medication immediately. A social worker can help with this process and can help people find solutions if paying for the medications is a problem.
