Home Discharge: Planning, Policies, and Impact on Hospital Admission and Outcome

Abstract

Hospital discharge of elder patients with multi-morbidity and poly-pharmacy is challenging and requires standard procedures to ensure the transfer from hospital to ambulant nursing care properly. The situation is even more challenging when patients are discharged with oxygen and/or NIV becomes. There are tremendous organizational requirements to ensure that the patient is supplied with oxygen at home at the time of hospital discharge and to guarantee that a NIV newly implemented at hospital is connected correctly by the patient. Since this may not be managed by the discharging doctor at the hospital, a discharge coordinator is necessary who integrates the patient, his family, the doctor, caregivers, technical health care providers, and the family doctor. A checklist is helpful to ensure that all the necessary information regarding therapy (medication, oxygen flow rate, NIV parameter settings) and clinical condition (mobilization, feeding, do-not-resuscitate/best measure only/no-readmission order, palliative therapy) is given by the discharge letter which has to be delivered promptly. By this, the transfer of complex patients may be enhanced and hospital readmission rate and emergency department visits may be reduced.