When people have recovered sufficiently or can be appropriately treated elsewhere, they are discharged from the hospital.
To determine when people should be discharged, the doctor weighs the risk of developing a problem due to being in the hospital (such as getting an infection) against the benefits of being treated in the hospital.
If people can be appropriately treated outside the hospital, it is usually better for them to be at home, even if the illness that brought them to the hospital has not yet completely resolved.
People can complete their treatment outside of the hospital if
- They are able to take food, water, and drugs by mouth.
- They can obtain the prescribed drugs.
- Their pain is reduced to tolerable levels (but not necessarily completely relieved) by drugs.
- They can move around their residence and care for themselves or have the help needed to do so.
- Their condition no longer requires advanced daily monitoring with hospital equipment.
- Follow-up appointments with their doctors have been arranged.
Before discharge from the hospital, staff members may evaluate people's ability to move around safely and ask questions to determine whether they are likely to need extra help after discharge. A discharge planner or a social worker at the hospital can anticipate which problems are likely, then make suggestions about and arrange for needed home health care services, which may include a visiting nurse, a visiting physical therapist, and equipment, such as a wheelchair or shower bench. However, people and their family members should be involved in these plans to make sure they are appropriate.
If further care is needed temporarily or permanently after a hospital stay, people are often sent to another facility. They may go to a rehabilitation facility or a nursing home (skilled nursing facility).
Before leaving the hospital, people or their family members should make sure that they receive detailed instructions for follow-up care and that they understand the instructions. They should get a written schedule for using all their drugs and for follow-up appointments. Unless arranged before discharge, upon arriving home, they should call their regular doctor to make a follow-up appointment. Telling the doctor's nurse or scheduler that they were just discharged from the hospital and that they need an appointment within the next 3 to 10 days is important to assure that they receive appropriate follow-up care.
If people are being discharged to another facility, a written summary of their hospital evaluation and treatment plan (called a transition care record) should be sent with them and another copy faxed to the facility.
Regardless of whether people are being discharged to another facility or are going home, they should be given written paperwork that includes the following:
- The reason for the hospitalization
- Major procedures or tests done
- The main diagnosis at discharge
- Any recommended dietary restrictions or modifications
- Any restrictions on activity (such as walking, exercising, or driving) or movement
- The need for assistive devices, such as a wheelchair, a walker, crutches, a CPAP (continuous positive airway pressure) machine, or oxygen
- Instructions for care of any surgical incisions or wounds
- If applicable, instructions for how and when to measure their temperature, blood pressure, blood sugar, or weight at home
- A list of any symptoms that require them to contact their doctor or return to the emergency department
- Dates and times of follow-up appointments with their doctors
- A list of current drugs, including what doses should be taken, how many times a day the doses are taken, and how long the drugs should be taken
Sometimes after people are discharged, their condition worsens, and they have to return to the hospital for additional care.
Most people are given prescriptions for new drugs when they are discharged from the hospital. Sometimes people have trouble obtaining these drugs. For example, their preferred pharmacy may not stock the drug, or their insurance may not cover the costs and they cannot afford the drugs.
Sometimes people get their drugs through a mail-order pharmacy, and it takes several days or a week to get the drugs. This delay can be dangerous because some drugs (such as antibiotics or anticoagulants, which prevent blood from clotting) must be started immediately after discharge, and to prevent serious complications, people must not miss a dose. To avoid any delay, people should ask their doctor to electronically submit or fax the prescription to a local pharmacy, and they should call the pharmacy before leaving the hospital to verify that they can obtain the drug immediately. A social worker can help with this process and can help people find solutions if paying for the drugs is a problem.