10 Questions You Need Answered Before Leaving the Hospital
September 6, 2019
By: Nancy Littke, PT
In today’s health-care environment, hospital stays are shorter, and patients are being discharged sooner than they may expect. Over time, the criteria for discharge have changed from complete resolution of a condition to a point where the patient’s care needs can be managed elsewhere. This may include transfer to a different level of care site or, more commonly, home.1 Discharge planning often starts at admission; however, discharges may come up suddenly. This can result in patients and their caregivers feeling overwhelmed with information and concerned about their readiness for discharge. There may be little opportunity to think of and ask questions.
How does asking questions help you successfully stay at home after being discharged?
Planning ahead, asking questions and developing good discharge plans can help to prevent complications and hospital readmission. Research shows that one in five patients experience an adverse event (an event or situation which caused unnecessary harm to a patient or could have caused harm) within a few weeks of discharge and that one in three of those could have been prevented.1 Unplanned hospital readmissions rates related to these adverse events vary between 13 – 20% and lead to increased suffering, harm and costs to both the individual and the health-care system.1,2,3 Ineffective communication and coordination of care between hospital staff and patients and/or care providers has been found to be a significant cause of hospital readmissions within 30 days of discharge.1,2,3,4
The good news is that research suggests that patients who have experienced good discharge planning and who have a clear follow-up plan demonstrate better post hospitalization health, experience fewer hospital readmissions and see a decrease in overall health-care costs to the patient and/or the health-care system.3 Patients and families can help reduce the risks of experiencing difficulties after discharge by taking an active role in their care and discharge planning.
The caregiver’s role in discharge planning
You may find yourself in the position of being the caregiver for a loved one who has become unable to independently care for his or her self. You may be new to this role, or you may have been providing care for a long time. This can be a challenging experience for both caregiver and patient as they adjust to new or different roles.
If you have been a caregiver for a long time, you will be able to provide the discharge team with important information about your loved one, the home environment, your caregiving abilities and resources needed to provide a safe home setting.3 If you are taking on new responsibilities you may be unsure about what is expected, what you need, and your ability to assume the caregiver role. You may have other obligations that affect your ability to provide care, or health concerns of your own. You may need instruction in how to provide help with daily activities or assisting the other person to move around the home.
In either case you will be playing a key role in ensuring the success of the transition home and need to be involved in discharge planning. Advocating for both yourself and the patient is crucial to ensure the discharge team is fully aware of any barriers or difficulties that may affect the safety and success of the discharge plan.
It starts with you – ask questions
For patients and caregivers to feel prepared, they need to understand what happened in the hospital and what is expected to happen after discharge.
Start planning early by making a list of questions that you need answered during the discharge process. Do not rely on memory to think of questions, write them down as they arise. Discharges can come up suddenly - you may not think of everything in the moment and could arrive at your discharge destination without the information you need to make the discharge successful.
Ensure you understand the answers to your questions. It may be helpful for the patient to have a family member or friend accompany them throughout the discharge process to write down the answers and keep track of all the information being provided. Keep all your notes, questions, and information in one place for future reference.
Questions patients should ask the care team
Getting answers to these 5 questions will help you, the patient, successfully transition from hospital to home.
What is your current status?
What is the final diagnosis?
What happened in the hospital?
What treatments did you experience, and what tests were done?
What can you expect in the future?
What medication will you need when you go home? As many as 40% of seniors over 65 experience potentially dangerous medication errors after leaving the hospital.3,4,5 It is essential that you understand:
What medications will you be taking after you go home?
Are these different than what you took before being admitted?
How long will the new medications be taken?
Any potential side effects to be aware of?
When and how do you take the medications?
If help is needed to manage or remember to take the medications, what plans are in place to assist you?
Make sure that your primary care physician and your regular pharmacist have a copy of your new medication list. Using only one pharmacy that is familiar with your history to fill your prescriptions will help ensure they are aware of all your medications and can identify any potential problems.1,3,4,5
What problems do you need to be aware of and watch out for? Ask about possible warning signs related to your diagnosis.
How long will it continue to hurt?
How much pain is too much pain?
How much longer should you be coughing or continue to feel ill?
What are the signs of infection or other complications that you should be watching for?
Are there any signs or symptoms that should make you go directly to the hospital?1,3,4,5
Get specifics related to you and your condition from your physiotherapist or other health-care professional in addition to any information handouts that may be provided.
Who to contact?
Get specific contact information and details about who to call for a specific concern and when. For example, you would contact the physiotherapy department for mobility-related concerns, the pharmacist for medication-related questions, or the surgeon’s office for questions related to your surgery. Make sure your family doctor is notified that you are being discharged so they are not surprised if you call with questions/concerns. Ask for copies of your lab/x-ray reports and medication list.1,3,4,5
What are the plans for after discharge?
If external help is needed, have arrangements for home care or caregiver services been made?
Have appointments been set up for any laboratory or diagnostic tests required after you go home? Do you have the contact information so you can set up the appointments yourself?
Has a follow-up appointment with your family doctor, surgeon or other specialist been booked?
What regular monitoring (e.g., blood pressure, blood sugar) is required and who will provide it (you, your caregiver, a homecare nurse or other)?
If you require assistance with dressing changes, skin care, medications or managing incontinence, who will provide it? Are they trained and able to provide the needed assistance? If not, who will provide the training? Can it be completed before discharge?
Questions to ask your physiotherapist
Will you require ongoing outpatient physiotherapy? Has the physiotherapist made arrangements for ongoing treatment or are you expected to do so?
Discuss with your physiotherapist any questions you have about how you will get home.
Can you drive yourself, will a family member need to pick you up or will you require special transportation?
Are you able to get into the vehicle and, if not, how will you manage?
What happens when you get home? Ensure your caregiver is able to get you and your equipment out of the car and into your home. If not, can they receive training so they can help you?
What can you safely do on your own and what should you have help with?
Can you transfer to a chair or your bed independently?
Can you walk and climb stairs alone or do you need someone close by?
Do you need a walker, cane, or wheelchair to get around your home or community safely?
Are any movement restrictions temporary (clarify how long) or are they permanent?
If you need help, does your caregiver know what to do, how to do it, and how to use any equipment?
Describe your home to your physiotherapist (e.g., do you have stairs? railings?) Are modifications needed? Should modifications be made before you go home?
What equipment/supports/supplies do you need when you get home (e.g., wheelchair, walker, tub bars, toilet rails or a bath lift)?
Is there a cost and if so, who will pay for the expense?
Where do you get the items? Can you or a family member get the items before discharge?
What do you do if there is a delay with getting needed equipment or supplies?
But I still do not feel ready!
It is normal to feel anxious about going home, especially if you have had a long or unplanned hospital stay. If you feel unsure about your ability to manage, tell the care team. It is important to take on the job of advocating for yourself and/or your loved one to ensure the transition from hospital to home is as smooth, organized and planned as possible, to increase the probability of success.
It is also important that caregivers are clear about what assistance they are willing and able to provide after discharge and raise any concerns they have about the safety of the discharge plan or home environment. Ask what other options or services may be available and advocate for yourself or your family member.
Hesselink G, Zegers M, Vernooij-Dassen M, Barach P, Kalkman C, Flink M, et al. (2014) Improving patient discharge and reducing hospital readmissions by using Intervention Mapping. BMC Health Services Research 14, Article number:389. Available at https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-14-389#Sec11
Naylor MD, Grooten D, Campbell R, Jacobsen BS, Mezey MD Pauly MV, Schwartz JS. (1999) Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. JAMA 1999 Feb 17;281 (&): 613-20. Accessed July 24, 2019. https://www.ncbi.nlm.nih.gov/pubmed/10029122
Family Caregiver Alliance: National Center on Caregiving. Hospital Discharge Planning: A guide for families and caregivers. Available at https://www.caregiver.org/hospital-discharge-planning-guide-families-and-caregivers.
The Austin Diagnostic Clinic. 14 Questions you need to ask before you leave the hospital, nursing home or other care setting. Available at https://www.adclinic.com/14-questions-before-you-leave-hospital/
Senelick, R. (2012)The 5 things you must know before leaving the hospital. Available at https://www.theatlantic.com/health/archive/2012/02/the-5-things-you-must-know-before-leaving-the-hospital/252177/
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Regulating Alberta's physiotherapy profession and acting as an association by providing member services.