This post originally appeared at The Atlantic.There are days in our lives that bring great joy to our hearts and a smile to our faces. Like the first day of school, with all of the anticipation of the new year, or the last day of school, with the summer months just waiting for us to relax.
Our wedding day and the birth of our children. Then there is the day we get to go home from the hospital after a surgery or sickness. We view this day as a major step from illness to recovery, but it is also a potential disaster for the ill-prepared.
Hospitalizations have become an accelerated process and are described by Edmund Pellegrino in his essay on human dignity as “today’s mechanised experience of illness.” Hospital stays are getting shorter every year and discharge doesn’t occur when you are healed, but instead at a point where you can go to a less expensive location to recover. Most commonly, that place is your home. The only guaranteed aspect of your transition home is that it will not go as planned. You will be bombarded with more information than you can keep straight. My wife and I just went through this process, and even though I am a physician, there have been multiple times when we have looked at each other and asked, “What do you think he/she/they meant?”
Many hospitals, including the one where I am the medical director, have worked hard to improve the discharge process. But despite our efforts, our patients and families consistently rate it as one of the least satisfactory aspects of their hospital experience. In an attempt to reduce the number of patients who are readmitted to the hospital less than 30 days after they leave, Medicare and other insurers have focused on this process, and next year will begin penalising hospitals if a patient returns.
THE 5 THINGS YOU MUST KNOW
Medicare has created “Your Discharge Planning Checklist” (PDF). This six-page document lists 22 different areas to cover with your doctor and health care team. In an ideal world, medical professionals would help you go over all of these points. But, in the excitement of getting to go home, few of us are likely to make it through the whole list. Here’s my top five.
MEDICATIONS: It seems obvious, but this is the greatest source of confusion. You have the medicines at home that you were taking before you came to the hospital. When you checked into the hospital, these same medicines may have been changed to a generic or another equivalent medication that was substituted for the one you took at home. You may not be aware that the new prescription that the doctor gives you at discharge is really the same medicine you’ve been taking before. This may put you at risk to take a harmful double dose. You need to have your nurse or doctor carefully go over your old and new list to make sure everyone is on the same page. Another tip: Only use one pharmacy, so that the pharmacist will have a record of all your medicines and can identify any potential problems. Have the hospital or pharmacy fax your final list of medications to your primary doctor. So often the doctor who takes care of you in the hospital is not the doctor who will follow you once you go home.
RED FLAGS: When you are in the hospital, help is only a call buzzer away. Spike a fever and a nurse will draw your blood. Cough up something green and you will get a chest x-ray. But, once you are home, it is hard to know what warrants a call to the doctor. Don’t settle for the computer-generated form that the hospital hands out to patients. Ask your doctor for your specific condition’s red flags. How much pain is too much pain? How long will it continue to hurt when you urinate? How much longer will I be coughing? Is there anything special that should make me run to the hospital, rather than call my doctor?
WHO TO CALL: Get the specific phone numbers of who to call if there is a problem. My wife had surgery on a Friday, so I asked the doctor for the name of who would be on call that weekend, and if he would let them know that we were out there. Make sure that someone at the hospital you are leaving lets your primary care doctor know that you are loose on the street. I always give patients a copy of their entire lab and x-ray reports to carry back to their main doctor. If they get into trouble before a scheduled appointment, then they have the critical information with them.
FOLLOW-UP: One of the main causes of readmission to the hospital is that the patient has not had appropriate follow-up after they leave the hospital. You may be told to see your regular doctor in 10 days, but when you call, they cannot see you for six weeks. Have the nurse or case manager at the hospital you are leaving call and make the appointment. Insist on it.
START A NOTEBOOK: At our hospital we give each patient a spiral WITH (Wellness Information & Tools for Health) notebook. It has sections for all of the things we covered and more. As a rule, when you come home from the hospital you have bundles of papers, some important and others destined for the recycling bin. Stick the important ones in a notebook or folder. The CMS website also has some good forms(PDF) to put in your own notebook. Take your notebook with you to each doctor’s visit so you have a list of your medicines, doctor’s names, laboratory results, and instructions all in one place.
If you cannot get all of these questions answered yourself, then assign one family member to be in charge of the process. It is our — your healthcare providers’ — responsibility to make sure you get the information, but ultimately, it is going to be your responsibility to remember everything, and make sure you have all of your facts straight. Whether you believe it is fair or not, no one is going to organise all this for you — it is your responsibility, and in your best interests, to get it together.
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