What to do before you leave the hospital

Do make sure you understand your discharge plan

One of the greatest causes of readmission to the hospital is patients not understanding their discharge plans. Sometimes these plans are written in shorthand summaries that leave lots of questions hanging. Sometimes they don’t make sense to patients. Make sure you go over all the details of the plan with a social worker, case manager or nurse. If instructions are not clear or are confusing, ask for clarification or further instruction. Be sure the plan makes sense to you and your family before you go.

Do be certain that the plan is realistic for you and your family

It’s one thing to know what’s expected; it’s another to be sure it’s realistic. Are you supposed to get physical therapy twice a week or see your doctor a week after you get home? Can you drive yourself or is there someone who can take you? Do you need new medications or home devices such as a walker or potty chair? How will you get these items? Discussing these details with hospital staff and with your family or friends is an important part of your successful transition home.

Do get copies of your medical records before you go

Sometimes the hospital will provide you with a summary of your medical care as part of your discharge plan, but sometimes you have to ask for it. Some hospitals even make patients pay for copies of complete files. It is important to have as much of your medical record as possible for your own reference but also for follow up with your regular doctors who were not involved in your hospital care.

Do make plans to follow up with your primary care physician as soon as possible

Most likely, your primary care physician will not be attending to your needs while in the hospital. You will probably be assigned to a hospitalist, a doctor who works for the hospital and manages patient care. But your hospitalist will not be involved once you leave the hospital, so it is critical that you follow up with your primary care physician and make sure he or she is up to date on your medical status.

Do ask someone you trust to visit nursing or rehab facilities in person

Your doctor may recommend that you go to a nursing or rehab facility to continue your care before going home. This is often the case for patients who need special postoperative treatment, intensive physical or occupational therapy or other specialized care. Hospital social workers may recommend facilities, but make sure that someone you trust visits several places in person to find the one best suited to your likes and needs.

Do not leave the hospital without knowing what to do in an emergency

As part of your discharge planning, make sure you know if there are any warning signs you should be aware of, such as fever, redness or pain. You need to know what symptoms are normal and which are cause for concern. Before you leave the hospital, ask your doctor or nurse for advice so you know what to do in an emergency. For example, should you call the doctor or return to the hospital emergency room if warning signs appear?

Do not agree to discharge if you feel you aren’t ready to leave

Sometimes patients are prepared for discharge before they feel ready to go home. The first step is to talk to your doctor. If there is legitimate, medical cause for concern, it may require appealing the doctor’s decision. Patients covered by Medicare have an important appeal right involving the state Quality Improvement Organization listed on the Medicare form that is part of the admission process. If you aren’t on Medicare, then raise your concerns with the hospital’s medical director or administrator.

Do not be afraid to voice your fears or concerns about going home

If you are afraid to go home for some reason or worried about taking care of yourself, you should discuss your concerns with a social worker, case manage or nurse before you leave the hospital. Older patients often have these fears and are worried about sharing them with family or friends. Giving voice to your concerns and, more importantly, developing a plan for dealing with them are important to your recovery.

Do not avoid discussing important restrictions such as diet, driving and sex

Patients are sometimes hesitant to raise questions about restrictions, especially if they think they may not like the answers. Be sure you find out what you are allowed to eat, when you can resume normal activities such as driving and when you can have sex. These may be touchy topics, but it’s important that you understand the doctor’s instructions and are prepared to make accommodations that may be necessary.

Do not assume that insurance or Medicare will cover all of your home expenses

If your follow-up care involves special treatment, such as intravenous drug therapy at home, your insurance or Medicare may not cover the costs which can mount quickly. Alternative arrangements may be possible, such as going to an infusion center. So be sure you discuss your needs and your coverage benefits with a social worker or case manager before agreeing to the discharge plan. You don’t need sticker shock on top of everything else.