Letter from the Chief Medical Officer
Dear Colleagues:
There are a number of elements and moving parts involved in a patient discharge, and now we are discharging more patients each day than ever before. For our patients and their families, that one discharge—the moment when they are well enough to go home or to another facility for sub-acute care—is all they are thinking about.
As care givers, we need to be thinking about that discharge starting at admission. Our nursing staff, Care Coordination team and house staff plan work towards discharge for each patient on every shift. It’s incumbent on attending physicians to work as a member of the care team through morning and afternoon rounds, direct contact with house staff and consistent review of progress notes in the plan of care.
Even after a discharge order is written, attending physicians may not be in sync with the rest of the care team. Without realizing it, we may undermine the rest of the team’s relationship and discussions with the patient and family. This happens when our patients have unfounded reservations about going home. The rest of the care team works closely with the patient and family around a specific discharge. But when the patient expresses apprehension about going home, sometime we placate the patient and allow him or her to stay later in the day, or an extra unnecessary day.
If it’s not medically necessary, this cannot happen with any frequency. I urge you to connect with the rest of the patient’s care team before reversing a discharge order. Our nursing staff know our patients and whether or not their reservations about going home are merited. Additionally, our nursing staff and unit managers are working closely with Admitting Services to put another patient in that bed.
Our reassurances that a patient indeed is ready for discharge—despite unfounded fears and concerns about leaving our care—positively affects the patient’s experience and supports the care team in its work. We cannot and should not make the decision to halt a discharge without consulting the rest of the care team.