Discussion
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Peer Response:
Instructions:
Lisa Ravanelli
A) The patient does not have a complete physical therapy note and she has been unable to transfer or walk. The therapist did tell the physician that the patient is not ready to be discharged for home.B) The pulmonologist ordered several tests but they have not yet been given to the physician so it is inconclusive and the orders are incomplete. Discharging the patient without knowing the results could result in more harm than good. I do think it would be beneficial for the team to be in agreement with letting the patient be discharged to home. It is obvious that the daughter is unable to care for her mother and she does have other priorities in her life work and a son. The social worker would need to get involved and see if this is a reasonable discharge, how often can the daughter look in on her or is there a home health agency that can help, will Medicare cover in-home health agency? This is where the opportunity for performance will need to step in, why are we discharging a patient when the whole team is not in agreement. A meeting to access the performance improvement of when the patient could be discharged makes more sense. The test that is not yet completed and or results received need to be addressed and why is there a hold? The opportunity of performance, resulting in the time of the test should be enabled and would think the physician would want to be ensured it is safe for her to go home. This is where we need to let the patient receive quality care by testing her and waiting for the test results. It is proper care and the right of the patient, we send her home and find that the test was incomplete this could result in malpractice.For the above responses, I think it would be beneficial for the physician to meet with the discharge team and they come to an agreement, even waiting out the test results. The cardiologist even increased her medication and this could result in another fall, we need the therapist to work with her a little longer and get her onto her feet and walking safely. The daughter needs to be reassured that we have her mother’s best interest in her care. The patient wants to g home and return to her normal routines, but it is not safe for her to return, she could sit with social services that can explain why it is not safe at this time. She is was even informed she is on a restrictive diet, this is essential for her heart. In the end, the physician even stated he was not aware of her living situation and just discharged her anyways, this is not good practice.
Sarah Lemieux
In this discharge planning there are a lot of concerns and problem areas. First, the most important problem for the big picture is there is lack of communication between each healthcare provider/department. There seems to be no active listening that took place between the discharging doctor and family member. The patient does have her rights however it is to the best interest of provider, family and patient that they are safe when they return to their home base.
Second, there are still pending tests and mobility are very questionable at this point. Assumptions can be dangerous and lead to readmissions from discharges which a hospital base frowns on because they can lose money with readmissions within a certain time frame. (Wolfson, 2017)
There are opportunities for performance improvement in this discharge planning system. The lack of bringing all information together to decide what is a best-case scenario for the patient and family, because 9 times out of 10, family are involved in cases like these. The biggest part of this discharge is to view all the information together to make a consecutive decision. The patient maybe ready in one part of the process but lack in the mobility aspect which can be very hazardous to the patient.
Ideally you would have a discharge planning team in place to help with all angles and concerns of the patient and family prior to discharge. The doctors, therapist, dietician, social services, patient/family and discharge planner need to communicate the needs and appropriate services that maybe needed to have a successful discharge. This patient is ready for discharge from a hospital but also needs extended services. In this case the patient needs to go to a rehab center for a short period before she is sent home to relieve burdens and risk factors for the patient to successfully recover.
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