Early Discharge Case Study

Patients recently discharged from acute care back to the community are at an increased risk for hospital re-admission (3). Efficient collaboration between interdisciplinary health professionals and nurse liaison can improve discharge planning processes.

The overall process of discharging a patient from a hospital and the transition back home or to a care facility are critical advancements in the overall course of both acute and long-term care. It is important that the hospitals releasing these patients have ensured the proper overall course of care from beginning to end. The lack of consistency with both the discharge process and the quality of discharge planning has led to many avoidable readmissions. To reduce the amount of hospital readmissions, it is imperative that hospitals recognize the need for focused patient care and that programs are being implemented to assist in the care transition.

A physician must understand that when it comes to deciding to withhold or withdraw life sustaining treatment it is ultimately the patient’s decision unless the patient is not competent enough to make this choice. I believe that a person can lose their life at any point. Death is certain and no one can run from it. In my opinion, a patient’s autonomy is of utmost importance anytime during healthcare however the physician can name some recommendations of what would be the best option for the patient. When it comes to patients they deserve to be treated with respect and ultimately be treated as an end not as a means to an end.

This week’s reflection paper focuses practice-based evidence and the operation of the theoretical framework of person-in-environment as each relates to discharge planning at UMPC Mercy Detoxification Unit (UPMC-MDU).

The hospital that I worked for while working as a case manager was not in network with Kaiser Permanente. It was also the time when the hospital started to hire hospitalists to manage patient care while they are a patient in the hospital. It actually worked out because it filled in the gap in patient care. The hospitalists were acting as the patient's primary care provider. Kaiser as with many other insurance have a case manager designated to ensure that the patient is meeting criteria not only for an inpatient hospital stay but for the level of care they are receiving as well such as ICU, Stepdown, or Med-Surg. I would have to give them an updated clinical information daily or every 3 days depending on the severity of illness. As a case manager, I was responsible for discharge planning and I preferred to transfer the patients to

Readmission to a hospital creates strain and added expense for the patient and hospital; in 2011, hospital costs due to readmission were almost $41.3 billion (Hines, Barrett, Jiang, & Steiner, 2014; Rau, 2014). There are many aspects of healthcare associated with readmission, such as lack of discharge planning and education, which need to be addressed i to decrease the amount of preventable re-hospitalizations.

Ineffective discharge teaching often leads to unnecessary admissions to the hospital resulting in negative patient outcomes and decreased patient satisfaction. This negatively impacts the well-being of the patient and creates a financial burden on institutions. As a result, this universal practice issue requires a call to action on the part of the nursing profession. Nurses can proactively assist in assuring incidents of readmission do not occur. Nurses as educators play a critical role in the successful transition of patients from hospital to home. The overall goal of discharge education is to ensure there is an exchange of critical information between the patient and nurse in which plans of care are understood and followed. The research

Patients with long-term, chronic illnesses like Mr. Davis’s, care can be very costly, especially when the patient is unable to maintain routine medical care or visits and medications. Without routine medical care and maintenance medications, patients like Mr. Davis tend to have more frequent emergency room visits and hospitalizations; increasing costs for state and local government as well as tax payers. Though Mr. Davis is able to receive care during an emergency room visit, the providers are not fully aware of his health history and are only able to provide a temporary fix of his symptoms and not address his health care needs.

This model reimburses hospitals based on quality of care instead of the volume of patients. The quality of care is assessed by patient questionnaires and if hospitals are unsatisfactory penalties may be imposed (Edwoldt, 2012). The value-based system also affects Medicare and Medicaid. It was reported that Medicare readmissions within 30 days of discharge cost 17 billion dollars annually (Edwoldt, 2012). Due to the high costs of readmissions Medicare and Medicaid have implemented a Hospital Readmission Reduction program. A formula is utilized to evaluate readmission rates within 30 days of discharge for any medical reason related to their original admission such as heart failure and pneumonia. Upon review the hospital is potentially penalized. It is important that nurses strive to provide excellence in care despite their beliefs on the ACA. Nurses have the ability to provide a safe patient environment and reduce the risk of hospital associated infections by following hospital protocols such as hand washing.

In some cases I can see where releasing one from the hospital could be somewhat beneficial for the patient, than it would be to stay and receive care there. If you think about it there are so many chances of infection setting in. Hospitals are full of sick people and germs are carried in and out of the doors regularly. I am aware that the homes of the patients are germ infested as well, but those germs are familiar germs that the person body more and likely has already developed immunity to. It may be better in some cases also for the person to be released because of the noise making it uncomfortable for people recover peacefully. It also may have nothing to do with the doctor’s decision to discharge the patient, but the patient’s insurance company. Insurance companies only give a specific number of days of stay for specific illnesses. If you want to stay longer because you still feel ill, you may have to pay for days they don't authorize. Insurance companies don't look at the patient; they look at the diagnosis only. It's a business decision, often not a medical one.

A doctor is legally and practically responsible for safely discharging her patients from a hospital in Ontario. This is an extraordinarily important piece of knowledge as a patient can communicate directly with her doctor about whether it is safe for her to be discharged at a particular

REQUEST, REASON, ISSUES, BOARD TYPE, AND DECISION: The applicant requests an upgrade of his uncharacterized discharge to honorable. The applicant states, in effect, he served for four years in the National Guard and deployed to Afghanistan in 2005 thru 2006. The applicant contends, he enlisted upon redeployment despite having Post-traumatic Stress Disorder (PTSD) symptoms and other medical problems. The applicant states, he requested counseling for his PTSD, instead he received a counseling statement informing him that he would receive an entry level status (ELS) separation with an uncharacterized discharge. The applicant further contends, he was diagnosed with PTSD and rated 40 percent disabled rating by the VA for PTSD. The applicant states, he had held a position as the communications sergeant with the McAllen Police Department after being discharged. The applicant contends, he is an upstanding member of the community has never been in trouble with the law, and this is evidence of his desire to serve. The applicant further contends, he served his country honorably as an infantry Soldier and an uncharacterized discharge for PTSD is wrong. The applicant states, an honorable discharge would do justice for the unfortunate administrative action taken against him in September 2006.

patient is no longer able to attend a hospital that meets their needs, the lives of the individual’s

For years, healthcare costs have continued to increase in the United States and policymakers are constantly trying to find ways to reduce spending. According to reports, in 2011, about $900 billion out of the $2.6 trillion annual health care spending was wasteful spending. In the following year, there was a reported $690 billion wasted annually on healthcare. This wasteful spending is attributed to ineffective health care delivery, cost of adverse events, and poor care coordination that has led to avoidable readmissions (Lallemand, 2012). In the United States, readmissions are the highest amongst patients with chronic diseases accounting for about 90% of avoidable readmissions in 30 days after discharge, and costing the industry an estimated $17 billion. These readmissions are a result of inadequate discharge planning, lack of follow-up, and lack of education on disease management (Jayakody et al., 2016). Policymakers on the federal and state level have developed and implemented several programs, some varying state to state, to help reduce wasteful spending while improving quality of care.

Discharge planning and management with an elderly person can become very complicated and should be approached with an open mind and the willingness