This month I wanted to write about our work on modifying the discharge huddle process and the purpose.
I like to think of the patient’s hospitalization as a journey, similar to any road trip you would plan. You would pack your car with your bags and fill the tank with gas. Your bags would have clothes and shoes for all weather conditions, just in case. You may plan to stop along the way to see different sites, pick up souvenirs, take pictures and eat at a restaurant you have heard so much about. Armed with a spare tire in the trunk, extra cash, and maybe an umbrella, you hope for a smooth trip, but are prepared for the unexpected. You have an expectation of the day and potentially time that you will arrive at your destination. Most of the time, this journey is uneventful, but occasionally, things come up. As you are driving, on your way, your “check engine” light comes on and you have to find a service station. With this detour, how do you get back on track?
This journey is analogous to the patient’s journey through their hospitalization. We prepare for the patient’s need by having the right people available to care for them, the right testing and procedural access, the right meds, etc.—all of these we have at the ready for that patient and their potential needs, just as we have done to pack our car. All patients have an expected length of stay for the diagnosis for which they present. Many of us, including the patient, do not know what that expected date of discharge should be, and that date may change based on the diagnoses that patient comes in with and acquires during their hospitalization. However, the unexpected may occur: they have a complication, their course is slower or faster than expected, they need help when going home, etc. What do we do as health care providers to make sure this patient gets back on track and discharged on time, as expected, safely?
The first is to make sure everyone on the team knows what is going on and what to expect. This communication should result in the team working together better and should eliminate some duplication of efforts. This need for this communication is the purpose of the discharge huddle. We know not everything goes as planned, so we prepare the best we can for each patient during their hospitalization. We schedule procedures, order consults, labs and imaging ahead of time. We prepare them for post-acute treatment needs, like skilled care and rehab and home health care, and schedule any follow-up appointments as necessary. We send prescriptions for their medications to the patient’s pharmacy. We do all of this to have a safe and efficient discharge for the patient.
Communicating and planning with our teams each and every day about each of our patients makes the journey through the hospitalization more effective, more satisfying, and safer. And when unexpected delays occur, we can quickly resolve them and get our patients back on track by working together as a great team.
Discharge planning truly begins at admission. It is important to discuss the discharge plan each day of hospitalization to ensure timely discharge.
—Theresa Brennan, MD, Chief Medical Officer