We have all seen the story or heard of a similar one: A woman in a hospital gown being wheeled to the bus stop by a security guard in freezing temperatures.
A nurse might have been the hospital representative who co-signed the final discharge paper before this patient was rolled out into the cold. If this was your patient, what would you be thinking at this point? Would you consider this an appropriate discharge?
Many consider this act “patient dumping.” Patient dumping is when a hospital capable of providing necessary medical care transfers a patient to another facility or turns them away due to inability to pay for services, as well as a premature discharge of a Medicare or indigent patient for economic reasons.
Because of this, a 1986 U.S. federal rule requires hospitals to advise Medicare patients upon admission of their right to challenge a discharge. However, this applies to Medicare patients only. Patient dumping is unfortunate, and it happens across the U.S.
Discharge planning is your responsibility, too
Hospitals also need to comply with section 482.43: Condition of participation on discharge planning. This states a hospital must have in effect a discharge planning process that applies to all patients and identifies at an early stage in the hospitalization all patients who are likely to suffer adverse health consequences upon discharge if there is no adequate discharge planning.
You might be thinking, “I am not the case manager or discharge RN for the patient.” But does that relieve you of the responsibility to plan appropriate care as the patient’s primary care nurse?
Based on the American Nurses Association Scope and Standards of Practice, you are responsible as the patient’s nurse — part of the team that assesses and plans for the patient’s care. It is your responsibility as the nurse involved with the patient’s care to appropriately assess and address healthcare needs.
Additionally, you must consider your professional and legal responsibility when it comes to discharging a patient who may not have had appropriate discharge planning.
Consider the following to help guide you in the discharge process:
1 – Question the discharge plan if you do not believe it is appropriate.
2 – Do request a social work or case manager consult if the patient has not been seen by either.
3 – Request a patient care conference and ask what the plan is for this patient.
4 – Read and understand your hospital’s discharge policy.
5 – Document in the patient record your input into the discharge planning.
6 – Use the chain of command in your organization if the patient’s issues are not sufficiently addressed.
7 – Understand your hospitals’ charity care options (i.e. taxi and bus vouchers).
8 – Start a charity closet with unisex clothing, socks, shoes and warm clothing items that can be given to patients being discharged without a place to go.
Recognize a patient may be discharged to no setting if they are homeless, and that in and of itself is not an unsafe discharge. Fully assess the patient’s clinical and social needs and plan for community resources, as appropriate, that exist in your community.
Now, what shouldn’t you do?
1 – Don’t think discharge planning is someone else’s responsibility, it’s yours as much as anyone else’s.
2 – Don’t justify an unsafe discharge because they are considered a frequent flyer in the system.
3 – Don’t discharge a patient you believe is going to be unsafe with unmet health and social needs.
This is a complex problem, but patient dumping should never be considered the solution. Many hospitals struggle to find adequate post-hospital clinical or social support in the community for some patients, placing increased burden on the nurse and the hospital. Remember, as the patient’s nurse, you are his or her advocate. You play an important role in the care of this patient, including the discharge.
Courses related to ‘discharge planning’
WEB298: Low Health Literacy/Discharge Education
(1 contact hr)
How many times have you considered whether a patient truly understood or would remember how to follow through with discharge instructions? Despite verbalization of understanding, how can you reinforce patient comprehension? The Institute of Medicine held a workshop dedicated to discussing this concept of patient comprehension with regard to discharge instructions. In fact, the US Department of Health and Human Services discusses how those with literacy proficiency can still struggle with health literacy. Increase your understanding of the state of health literacy and learn how to educate more efficiently.
CE696: Transitions of Care
(1 contact hr)
Nearly one in five Medicare beneficiaries discharged from the hospital is readmitted within 30 days of discharge at a cost of $26 billion a year. Three-quarters of those readmissions are considered potentially preventable, representing an estimated $12 billion in Medicare spending. While not a new problem, the Affordable Care Act has provisions targeted at changing this long-standing problem that affects patient outcomes and increases healthcare system costs. This program will familiarize nurses with the concept of care transitions and ways to improve outcomes and decrease avoidable readmissions.
CE169-60: Managed Care
(1 contact hr)
For nurses, the fallout from healthcare reform and the growth of managed care has not subsided. These issues have a daily impact on practice by shortening lengths of hospital stays and causing the earlier discharge of patients who require longer and more intensive care once they reach home. These changes challenge nurses and other providers to work harder, smarter and differently from traditional practice. This module addresses the origins, types and terminology associated with managed care programs.
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