How do I decide where a patient goes after they are discharged from the hospital?

In my last year of medical school, I spent some time hanging out with the ancillary staff at the hospital to learn about their perspective on taking care of our in-patients. I was completed humbled by what I didn’t know. For example, “building a referral to a nursing home” includes making a packet of the pt’s progress notes, pharmacy profile, and behavior, infectious, screens, and my case manager repeatedly referred to McKesson’s Interqual. She also taught me about the different levels of dispo for patients leaving the hospital.

Types of dispositions (discharge plans for patients):

  • Home without services
  • Home with services: including home healthcare (VNA), equipment (O2, hospital bed, etc), PT, infusion services, etc.
  • Nursing home: different types, like assisted living, nursing home, SNF
  • Rehab: for people who need PT, OT, speech/swallow problems
    • Acute: 3 hrs of work/day
    • Subacute: 1 hr of work/day
    • Long-term care: people on vents, dialysis, wound vacs, etc.

Points to carry forward:

  • Always plan your discharges the day before you actually discharge the patient
  • It is the doctor who is responsible for the dispo, not the case manager…the doctor is ultimately responsible for deciding, SNF? Rehab? Stay another day? so be very clear with case management about your plan for the patient
  • Communicate with your nurse, ALWAYS! Otherwise nurses may take it personally, or get thrown under the bus if they have 2-3 discharges they didn’t know about…
  • The biggest impedances to good dispo are a lack of supportive family, language barrier, transgender status

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