Plan ahead for discharge

Your caregivers say it's time for you to leave the hospital. That's great, but it's no time to let down your guard. You're actually approaching one of the most dangerous times of your hospital stay.

Research suggests that those who don't understand their patient discharge plans or how to manage their drug regimen are at increased risk of developing a drug interaction or some other problem that lands them right back in the hospital. Eleven percent of the patients in our survey were in the hospital because of a complication from a previous hospitalization or surgery. Of those patients, 19 percent said they had contracted an infection from their previous hospital stay.

Our analysis of government patient surveys found that people gave most hospitals low ratings for patient discharge instructions. (In our own survey, which was not a representative sample of all patients, the vast majority of respondents said they felt adequately informed about the medications and other care they'd need after discharge and had a contact for any questions or problems.)

One way to head off problems, our nurse respondents said, is to ask the hospital's patient advocate, social worker, or case manager to help review your patient discharge plans. One key step is called "medication reconciliation," which consists of comparing the medications you took in the hospital with the ones you were previously taking at home to make sure you leave with the medication regimen you need, no more, no less. If you don't see medication reconciliation in your patient discharge plan, insist that it be provided.

Another critical step: Before you leave the hospital, schedule an appointment with your primary-care doctor within a week after your patient discharge. Double-check to make sure your doctor receives copies of your hospitalization records and patient discharge plan. In fact, it's a good idea to take copies to your appointment, just in case. Patients should get follow-up care to "make sure that they're remaining stable and that there aren't any interactions with medications and so forth," says Williams of Northwestern University.

A surprising number of people neglect that step, according to a study, co-written by Williams, which found that almost 20 percent of nearly 12 million Medicare patients discharged from the hospital were readmitted within a month. In half of the nonsurgical cases, researchers found no bill for a follow-up visit to a physician's office, suggesting that inadequate post-discharge care might have contributed to the return hospital trip, according to the study, published in the April 2, 2009, issue of the New England Journal of Medicine.

What if the hospital wants to send you home before you feel ready? Ten percent of the patients we surveyed said they ran into that problem. Of that group, 54 percent requested a postponement and 42 percent of those were allowed to stay longer.

Summing up

• Make sure you understand plans for your patient discharge.
• If you're not satisfied, ask for help from your hospital's patient advocate, social worker, or case manager.
• Insist on a medication reconciliation between home and hospital drugs.
• See your primary-care physician within a week of your patient discharge and arrange for him or her to get copies of your hospital records.