When I initiate final hospital discharge planning, I am making a clinical judgment that the patient is safe to leave the monitored environment of the hospital system. Hospital discharge planning begins on the first day of admission. Sometimes the patient wishes to leave against the medical advice of the physician. Sometimes they refuse to leave at the advice of the physician. And sometimes the physician and patient agree it's time for the next level of care.
But how do you as a physician know to pull the trigger and write the order for discharge? A certain number of my patients will always bounce back into the hospital. The frequent flyer club is alive and real. Whether it's the natural progression of endstage disease, issues with medical compliance or access issues which result in readmission, it doesn't really matter. The best way to prevent preventable readmissions is to have system processes in place that maximize success with the discharge process.
Is there a defining patient characteristic which guarantees safe discharge from the hospital and guarantees complete immunity from prosecution should a bad outcome occur? That answer is yes. Here's a text I got from my colleagues at the scene of the crime:
Happy, the nurses told me your abdominal pain patient in room 503 was having sex last night. They walked in on her. Do you think it's safe to discharge her this morning?
The answer to that question would be a resounding yes. If patients are well enough to have sex in the hospital, they are well enough to be discharged from the hospital before they develop discharge. Looking down the road, I think the patient's actions opened up the hospital to liability. I wonder if this patient will sue the hospital for pregnancy related complications due to ongoing alcohol and tobacco abuse. It would appear to me that getting pregnant in the hospital would be considered a hospital acquired never event. No patient should ever get pregnant in the hospital. Perhaps this will require a smack down by the Joint Commission.
If your patient is having sex in the hospital, hospital discharge planning should be initiated immediately before you have to figure out if they need a script for for Flagyl, Zithromax or Rocephin. This hospital someecard helps explain.