As the daughter of an elderly mother who’s been hospitalized several times in recent years, Kathleen Buchanan knew that some hospital patients can feel overwhelmed by the documents they’re provided by hospital personnel when they’re discharged. “They hand you a stack of paperwork about a quarter-inch thick,” she says.
Such discharge documents can include important information about things like a new prescription drug regimen, finding an inpatient or outpatient rehabilitation facility, keeping track of doctor’s appointments, finding a medical specialist and shopping for home medical devices that need to be purchased. That kind of high volume of paperwork is daunting to most people, particularly elderly patients, Buchanan says.
Buchanan is a member of the Patient and Family Advisory Council at UMass Memorial Medical Center in Worcester, Massachusetts, where her mom has been hospitalized for “old people afflictions,” like a urinary tract infection, injuries sustained while suffering a fall and congestive heart failure. Buchanan talked about the issue with fellow PFAC members, and the council recommended that the hospital streamline discharge paperwork. They began doing so in October 2017, and now they send patients home with two to four pages of paperwork rather than a thick sheaf, Buchanan says. “It’s like a checklist, cut and dried, very easy to follow,” she says.
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Fully understanding discharge paperwork is one of the most common issues people face when they’re making the transition home after being discharged from the hospital, says Carol Thelen, a family nurse practitioner based in the Baltimore region. This can be a problem not only for older patients who’ve undergone surgery or other serious medical procedures, but for younger people, she says. “People are usually in the hospital for something serious, so they may feel overwhelmed when they’re being discharged,” Thelen says. If you’re being discharged from a hospital, it’s a good idea to bring along a family member, significant other or close friend to your discharge meeting to take notes and ask questions, she says.
Here are some of the more common issues facing patients as they transition home after a hospital stay, and strategies for coping with them:
Confusion over prescription medication. When a patient returns home from a hospital stay, his or her medication regimen often changes, says Dr. Steven M. Schwartz, a family physician in Chevy Chase, Maryland. That may mean the patient started taking a prescription medication at the hospital that has to be stopped, or continued, at home. It could mean the patient is directed to take a new medication for diabetes, for example, and follows directions to take it, but unknowingly is already taking the same drug under a different name. This can happen if the patient is prescribed a brand name medication and was already taking a generic version of the drug, or vice versa, or was taking a similar medicine in the same category, Schwartz says. Taking too much of a prescribed diabetes drug could lead to the patient experiencing life-threatening low blood sugar. “If you take two drugs of the same class, at the right dose, it’s double the same medicine,” he says. “Any risks of side effects for that drug go way up.” A good approach to avoiding such problems is to make sure your hospital physician or nurse checks the list of new medications you’re being prescribed against the drugs you were taking before your hospital stay, a process known as drug reconciliation, Schwartz says. You can also ask your pharmacist and your primary care provider to check your medication list. Also, your pharmacist can recommend over-the-counter health products that may be helpful.
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Reduced post-hospitalization mobility. If a patient is hospitalized for spine surgery, chronic obstructive pulmonary disease, heart failure or a hip replacement, post-discharge he or she will almost be much weaker physically than before the hospital stay, and may need environmental changes at home, says Susan Sender, senior vice president and chief clinical officer at Amedisys, a Baton Rouge, Louisiana-based firm that provides home health care for people recovering from illness, injury or surgery. The firm also provides hospice and personal care services. If you know you’re going to be physically weakened while recovering from heart surgery, for example, it’s best to work with a nurse or a physical therapist before you’re discharged to assess what changes you need to make in your home, Schwartz says. That could mean moving the bedroom from the second floor to the first floor, installing ramps to avoid traversing steps or putting in railings in the bathroom. “As soon as you know you’ll likely need adaptations at home, get the ball rolling,” Schwartz says. “If things are going to be physically challenging for you, it’s best to arrange for such adjustments as soon as possible. Delaying making such changes might extend your hospitalization.”
A need for support at home. If you’re recovering from surgery or chemotherapy, you’ll likely need help conducting the basic functions of living, such as bathing, preparing meals and doing chores, Thelen says. If you’re going to need professional assistance, like a physical therapist or a home health aide, ask during discharge whether a case manager or social worker could help line up such assistance. It’s also crucial to make an appointment with your primary care provider as soon as possible after discharge, certainly within two weeks. Your provider, whether a doctor or a nursing practitioner, can help you find health care professionals if needed. “You don’t have to do it yourself,” Thelen says. A network of family and friends can also help with tasks like meal preparation and chores, Schwartz says. “You need somebody around to help with personal care needs,” he says.
It’s important to keep in mind that when you’re returning home from a hospital stay, there’s a good chance there will be “loose threads” — unresolved issues that you and your health care team need to follow up on, Schwartz says. One common example of an unresolved issue would be a test that shows abnormal results. Such a result might require further exams and a post-discharge appointment with a specialist, he says. During the discharge process, the patient or family member or friend accompanying him or her should feel free to ask lots of specific questions about medications and follow-up appointments, Schwartz says. It’s also a good idea for him or her to ask this catch-all question: Are there any loose threads that the patient’s primary care provider needs to know about?
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That question is important because primary care providers can play a crucial role in helping a patient make a smooth transition home from the hospital, Thelen says. In fact, she says, one strategy that holds true for all discharged hospital patients, regardless of what they were treated for, how long they were hospitalized and their age or gender is seeing your primary care provider as soon as possible. And if you don’t have a primary care provider, get one, she advises. A primary care provider — who can be a physician, a physician assistant or a nurse practitioner — can help with an array of post-discharge issues, including lining up appointments with specialists and switching new medication not covered by your insurer to a similar option that is covered. Your primary care provider can also provide referrals to home health care professionals if needed, Thelen says. Getting such help could prevent a hospital readmission. “Your health care provider at the hospital may have told you what you need to do, but it hasn’t sunk in because you’re dealing with so many things,” she says. “Don’t try to do it all yourself. See your primary care provider as soon as you can, and no later than two weeks after you’ve been discharged from the hospital.”
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Easing the Transition Home After a Hospital Stay originally appeared on usnews.com
