Early or premature hospital discharge poses a danger to patients
New Medicare & Medicaid guidelines require hospital discharge planning, rather than pushing patients out the door
In my experience as a Houston, Texas medical malpractice attorney, I frequently encounter the problem of patients being discharged from the hospital too quickly, only to return a short time later in a deteriorated condition.
Healthcare professionals use the term “discharge planning” to describe the entire process of beginning care all the way through transitioning a patient from hospitalization to discharge to home or another facility.
In many situations that I have seen, hospitals, doctors, nurses, and caseworkers seem to have put very little thought into preparing the patient for a safe discharge.
In the course of my representation of medical malpractice clients, I closely review all of the medical records and then go over them with the clients. I cannot tell you how many times patients told me that discharge information contained in the medical records was never provided to them, either in printed or oral form.
Sometimes, this means that patients are discharged unaware of symptoms that they should be on the lookout for, which would indicate the need to return to the hospital. Other times, patients are not informed that they need to have a follow-up appointment with a specialist or even take certain medications.
In other situations, patients are discharged from a normal acute care hospital to a lower-acuity facility, like a skilled nursing home or rehabilitation facility. I have represented a number of clients in cases where serious injury or death occurred because proper discharge planning from the first hospital to the next facility did not occur, resulting in medication errors and treatment gaps.
Poor discharge planning is such a serious concern to patient safety that The Centers for Medicare & Medicaid Services issued new guidelines to hospitals in 2017. The new guidelines include the following.
Hospitals must develop discharge plans for all patients or have clear policies and procedures on who does not need a discharge plan. The new guidelines are clear that the discharge planning process should begin shortly after admission, rather than something that is rushed and done at the last minute. Medicare/Medicaid threatens sanctions against hospitals if discharge planning is not underway at least 48 hours before the patient’s departure.
Evaluating patient needs after discharge
The new Medicare/Medicaid guidelines require that hospital discharge planning including evaluation of the patient’s potential need for services after discharge, as well as the availability of the services. Discharge planning must also include an assessment of the patient’s capacity for self-care, or the availability of care from family members or caregivers at the location they came from.
Discharge planning design
Medicare/Medicaid requires that discharge plans be prepared by a registered nurse, social worker, or other appropriate staff member. The discharge plan has to match the needs identified in the evaluation and allows patient participation.
Initiating the plan before discharge
The new guidelines are clear that the discharge planning process should be collaborative, involving patients and their caregivers, as well as hospital personnel. Research has shown that patient safety and outcomes are improved when patients are taught, before discharge, about their disease processes, medications, treatments, expected symptoms, and how and when to give help, and also given supplies, such as bandages. The Centers for Medicare & Medicaid Services recommends that hospitals fill patient prescriptions before discharge and schedule follow-up appointments, to help ensure continuity of care.
We are here to help
I am encouraged to see the regulatory oversight and leadership that Medicare and Medicaid are asserting concerning the hospital discharge process. From my experience, I believe that patients are too often rushed out the door to open up a bed for a new patient, without any planning or assistance to help the patient continue the healing process at home or another facility.
If you or someone you care for has been seriously injured as a result of premature discharge from the hospital, or any other type of medical malpractice, call Painter Law Firm, in Houston, Texas, at 281-580-8800, for a free consultation about your potential case.
Robert Painter is an experienced attorney at Painter Law Firm PLLC, in Houston, Texas. A former hospital administrator, he represents patients and their families by filing medical malpractice and wrongful death lawsuits against hospitals, nursing homes, rehabilitation facilities, physicians, surgeons, and anesthesiologists.
Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.
A physician has to supervise the care and prescriptions of nurse practitioners and physician assistants under written, signed agreements [...]read more
On 4/1/2018, the new law will end the current practice where doctors can secretly enter a DNR order against patient and family wishes [...]read more
A physician has to supervise the care and prescriptions of nurse practitioners and physician assistants under written, signed agreements
On 4/1/2018, the new law will end the current practice where doctors can secretly enter a DNR order against patient and family wishes
This article was originally published in the September/October 2017 edition of "The Houston Lawyer" magazine
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