Deciding when to discharge a patient isn’t always a straightforward decision. While many healthcare providers will use precedent when figuring out the right time to discharge a patient, there are many variables at play. If you discharge a patient sooner rather than later, you’ll open a bed and save the patient money, but you’ll also run the risk of discharging someone too soon, leading to readmission several days later. If you wait too long to discharge a patient, you can make sure the person is completely healed, but they’ll be taking up a bed that could go to someone in need. You’ll need to balance various concerns and priorities when choosing when to discharge a patient. While some may believe that sooner is generally better, that may not always be the case.
Pros and Cons of an Early Discharge
Discharging a patient too soon can save the patient money, especially if they’re uninsured or having trouble paying for their care. If no one can afford to pay these bills, the hospital may have to eat the cost, so you’d be saving the hospital money as well. But you shouldn’t discharge a patient purely for financial reasons. If the patient’s condition has improved, sending them home early also helps them get back to their normal routine, which may include caring for their family or going to work or school.
But, discharging a patient early also means risking potential readmission, sending a patient back into the world before they’re healthy enough to be on their own. This will only add to the patient’s medical bills and the hospital may be penalized as a result.
Pros and Cons of a Late Discharge
Discharging a patient too late will run up the person’s hospital bills, potentially costing them thousands of dollars. If the patient can’t afford to pay for their care, keeping them in a bed longer than necessary will force the facility to eat those costs. Keeping a patient too long also keeps them away from life’s obligations, which may involve showing up at school, going to work, or taking care of children or loved ones. If a mother or father can’t find someone else to look after their children while they’re in the hospital, keeping them longer may not be an option.
Of course, keeping patients a bit longer also prevents readmission, giving you and your colleagues plenty of time to treat their condition and make sure they’re healthy enough to be on their own.
Factors to Consider
- Where Is “Home”?
Where the patient lives should be top of mind when deciding to discharge them. If an older person still lives alone, you may want to wait to discharge them until you’re sure they can live by themselves. You might also want to wait to send a patient home if it means sending them back to an abusive environment. You should also consider the property itself. If a patient lives in a remote environment where it may take several hours for an ambulance to reach them, you might want to hold off on discharging them. Additionally, patients that live on the top floor of a building may need additional assistance and certain accommodations before they can return home.
- Time of Day
You should avoid discharging patients at night, especially if you’re worried they may have trouble getting home. Let’s say a patient comes in at night with an infection. It heals after 24 hours and you’re ready to send them home. But this person may not be fit to travel around at night. In this case, you might want to wait until morning to send them home.
- Frequent Readmissions
Look at the patient’s medical records. Do they have a long history of frequent hospital readmissions? If that’s the case, you might want to keep them little longer until you’ve addressed the core issue that keeps bringing them back to the hospital.
- How the Patient Feels
Perhaps the biggest determining factor will be how the patient feels. Even if precedent tells you that the patient should go home after three days, they may tell you that they’re feeling much better on day 2. If their vitals look normal, you could send them home early.
On the other hand, precedent might tell you to keep a patient for 24 hours, but the next day the patient is still suffering from chronic pain. In this case, you should probably keep them longer than you normally would.
With all these factors in mind, it’s important to remember that figuring out when to discharge a patient should be a group decision. Consult with your colleagues, the doctor, nursing supervisor or another medical professional for feedback and advice.