specific information like “care for yourself at home.” Say, “I’m providing you with information about how to care for yourself at home. I’m going to review symptoms to watch for and talk with you about when to call us. But just a reminder, this is all written out for you in your discharge instructions.” Using those key words and emphasizing them by pointing to the related content in the instructions can be helpful to a patient and family members. This also sets the stage for a successful discharge follow-up call.
Discharge Essential #3—Be clear about next steps
Avoid surprises. Be as clear as possible about what the patient should expect next. By handing patients their discharge instructions in writing and talking through that, you’re going to help avoid surprises. Having discharge instruction conversations in the presence of a significant other or caregiver will also reinforce crucial information.
In my mystery shopping endeavors, I frequently see providers send the family member out to get the car, then proceed to rattle through discharge instructions with just the patient. The feedback we often get from patients about this is that they didn’t remember half of what was said and were more focused on getting out. The feedback we get from family members is usually frustration about not being included in such crucial information.
One family member stated, “I had no idea what was going on. I was told to get the car, so I did. I never would have dreamed they would let my wife go home without me hearing every part of the instructions. After all, I’m the one who is caring for her at home.”
In focus groups, many patients have relayed how frustrating it is to leave the hospital or even the physician’s office wondering, “When are my lab results going to be ready?” or question, “Was I supposed to schedule the appointment or were they?” If a patient is leaving without final results, always tell her how long it will take to get results and who will be contacting whom with the results. If you have instructed the patient to call for results, be sure that you are giving her the correct information and you are prepared to answer questions when she does call. If you expect the patient to make her own follow-up appointments, make sure she knows this as well.
One focus group participant told me how she had left the hospital with instructions to call for her biopsy results. She called and was repeatedly told to call back. First, it was because staff didn’t have the results. After that, it was because they had the results but weren’t allowed to give them to her, and the doctor was out of the office. The patient went from being scared about her results to being furious with the doctor, his staff, and the entire organization.
Patients frequently mention that it is a big dissatisfier when the discharge staff isn’t clear about who is supposed to call whom. Consider their possible concerns: “Am I calling the clinic? Is the clinic calling me? When should I expect that call? Do I need to make my own follow-up appointment or has that been made for me? When is home health coming? When and where do I go for physical therapy? Who is making the referral?”
These are things that come up over and over with patients regarding their PD experience. They may not even realize who to call in order to get questions like these answered. The goal is to make sure that everyone is clear about next steps.
Discharge Essential #4—Include a follow-up plan
We send a lot of messages to patients in marketing, public relations, and advertising about how much we care about them. We talk about our quality and about all those things we think are important and want them to know. Yet, when they walk out the door, and we don’t make a PD call, what’s happening next?
Think about three key objectives, one being patient satisfaction or customer service. You want patients to maintain a “warm and fuzzy” feeling and remember you are concerned, caring, and compassionate. The second objective involves clinical outcomes. You want to make sure that patients understand discharge instructions and what to do next. The third is service recovery, an opportunity to fix problems and make amends where appropriate.
Without a discharge phone call, chances are the next encounter with that patient from your organization is going to be the bill. It’s a very cold communication piece that has nothing to do with physical recovery and certainly won’t ease anyone’s concerns about service issues. What should you do? Manage that expectation and keep the connection with patients by letting them know how soon they will be getting a call from your discharge staff.
Consider the message you send when you discharge patients without follow up. In their minds, they’re still worried, still scared, and still feel like they’ve got questions and need support. So, tell them that you’re going to follow up, and then do it!
The best time to make follow up calls is within the 72 hours after discharge because this is the point where some new or unexpected symptoms arise. It is also the time when you can make sure that patients understood their discharge instructions, and you can reinforce the most important information, including what to do to take care of a wound or scheduling any other kind of follow up that needs to get done.
If you’re on the phone and you hear things that indicate a potential adverse outcome or even a potential readmission, you can address this immediately in the conversation. The call is a continuation of care, a part of the treatment process that improves the opinion of your service as well as clinical outcomes. It is simply the right thing to do.
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