Discharge planning is fraught with challenges for hospitals, according to a new report, but effective communication and adaptability can help providers avoid them.
The United Hospital Fund, a New York-based nonprofit focused on improving the healthcare system, surveyed frontline staff and administrators at eight New York metro area hospitals to get a better picture of the challenges they face to determine the best choice of care.
A major problem, according to the report, is that a patient’s status often changes rapidly, which means the discharge plan must adapt as well.
Joan Guzik, director of quality improvement for the UHF Quality Institute and one of the authors of the report, told FierceHealthcare that this problem may be made worse by the pressure on the clinical team. to treat and refer patients quickly and efficiently.
“Even if this is a short stay, the best plan and setting for their outing might not be known,” Guzik said.
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That may mean establishing more than one potential post-acute care plan upon admission and then adapting to changes in the patient’s condition to meet their specific needs, according to the report.
Regulations aimed at boosting patient choice may also give providers the impression that they cannot make recommendations for qualified nursing facilities or other post-acute care options, even though patients often ask. this information, according to the report. The information patients receive is often found in a printed list and usually does not detail quality scores or other data useful in choosing a post-acute care facility. In some cases, the patient or a caregiver is invited to visit and tour the facilities themselves, but within a tight exit deadline which is often not feasible, according to the report, and they may not be clear on the warning signs to look for in a home visit nurse.
Patients can be referred to access online assessments from the Centers for Medicare & Medicaid Services through Nursing Home Compare, but they rarely do, according to UHF. This poses a particular challenge when the patient may not speak English, Pooja Kothari, RN, program manager for UHF and the other author of the report told FierceHealthcare.
“Patients who have poor health literacy skills or who do not speak English are not as comfortable doing research online and are also particularly in need of special information and support,” said Kothari.
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Kothari said some providers are relatively unfamiliar with Nursing Home Compare and may find it difficult to contextualize what assessments mean for patients, which could pose another communication challenge. In addition, the quality data available may not address the concerns of individual patients and their families, Guzik said.
“There is quality information available to the public, but it is not necessarily information that is really what patients and families want to learn,” she said.