From the minute a patient is admitted to the hospital, doctors, nurses, and support staff should begin thinking about what care, equipment, and supplies the patient will need upon release from the hospital. While responsibility for discharge planning is shared by all of these healthcare providers, many hospitals use a case manager or social worker to take the lead.
Thinking back on my time as a hospital administrator, I recall that the buzzword that we use to describe this is continuity of care. As a Houston, Texas medical malpractice attorney, I know from many cases that when there is a break in the continuity of care, there can be disastrous consequences.
That’s exactly what happened to a lady who went to a Kingwood hospital one December because of a heart issue. An interventional cardiologist recommended a simple procedure to go through her leg and repair a valve that was causing some problems.
After the procedure, she experienced intense pain and her oxygen levels were off. In fact, things were so dicey, she spent some time in the intensive care unit (ICU) before being transferred to a regular room.
Near the beginning of her stay, a case manager stopped by the patient’s room to discuss arranging home healthcare for her when she was discharged. While it was nice to see that planning early on, unfortunately, that was the last time the patient or her husband ever saw the case manager.
As Christmas approached, she was still in the hospital. Three days before Christmas, the nursing staff called her husband, who was at work, and told him to come and pick her up. She had been released. He was surprised by the suddenness of the discharge decision and explained that they didn’t know anything about any home health arrangements, medications, or supplemental oxygen at their home.
In short, they were concerned that there were no proper arrangements at their home to take care of her on such short notice. A nurse explained that a hospitalist, not the patient’s regular doctor, had discharged her. When they got the hospitalist on the phone, he was rather short and rude, and told them to call her own doctor.
As feared, home health didn’t show up on December 22, or December 23, or December 24, or December 25. They call the hospital repeatedly during this time period, but no one called them back. On December 26, someone from the hospital called back and said they couldn’t find any home health providers in Livingston, where the couple lived.
With no further response after two days, the patient’s husband called the hospital’s director of case management and was assured they’d get home health to them promptly.
Two days later, still with no home health providers, this poor lady went into cardiac arrest and her husband urgently called 911. Paramedics tried to resuscitate her, but it was too late. Back in the Kingwood hospital, a doctor explained that she had gone too long without oxygen.
A compassionate nurse involved in the patient’s original care at the hospital asked her husband why she hadn’t worn her Life Vest. When he explained that they didn’t know anything about a Life Vest, the nurse said that home health was supposed to deliver it to them on the very first day.
Discharge planning safety
In my experience, many hospitals get in a rush to discharge patients when insurance, Medicare, or Medicaid benefits are about to run out. I believe that sometimes these financial motivations outweigh patient safety.
I recommend that patients and family members take an active role in their discharge planning by asking doctors, nurses, case managers, and social workers about when discharge might occur. If home health, equipment, or supplies will be needed, try to independently verify that they’ll be promptly available before leaving the hospital.
The advantage of taking a proactive approach on your discharge is that nurses are required to take a more forceful role in patient advocacy while you’re still admitted to the hospital. If you feel pressured to leave, despite discharge planning concerns, ask to speak with a charge nurse or risk management to explain your fears and have them documented. That should get the attention you need.
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Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2018, by H Texas as one of Houston’s top lawyers. In May 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.