Adrianne has a master's degree in cancer biology and has taught high school and college biology.
Whenever a patient is admitted to the hospital, everyone has one focus and concern. The focus is successful patient discharge, or the release of a patient from the hospital. You and the rest of the healthcare team are going to meet this focus through discharge planning, which is a plan of action to address the needs of the patient in the hospital setting and after discharge.
During the process of discharge planning, you want to make sure that you as a nurse and other healthcare workers are thorough enough to decrease the likelihood of the patient being readmitted to the hospital for anything related to the current hospital visit. You need to know and think about the potential risk factors for readmission as you are doing discharge planning. Let's review those risk factors now by looking at what is going on with our patient, Will.
Arguably, the most common risk factor for readmission is premature discharge and/or inadequate support following discharge. This risk factor has to do with the patient being released from the hospital before reaching an acceptable point in treatment or health status. This could happen to Will if he isn't fully assessed prior to discharge. Failing to recognize a potential future need may cause Will to have inadequate support after discharge.
A separate, but related risk factor is when a patient is discharged against medical advice. Will leads a very busy life and just wants to leave the hospital or refuse the treatment at the hospital. This is a huge risk factor in that the health care team realizes that Will is not up to a certain health status. There's a very good likelihood that the patient will return in a very short period of time for the same health concern, or one that is more complicated, due to failing to receive treatment sooner.
Another risk factor, insufficient follow-up after discharge, is one that you yourself may have experienced. Have you ever been told to make an appointment with your PCP about a week after being discharged from the hospital, but you didn't go because you felt better and didn't think there was a need to go? Patients do this all the time and it puts them at risk. This risk factor could be the fault of multiple parties. The hospital team could be responsible if information was not successfully communicated to Will regarding his need for a follow-up appointment with a primary care physician (PCP). Responsibility could fall on Will if he simply doesn't go to the follow-up appointment. It could be the fault of Will's caregiver if he or she fails to take will to the follow-up appointments.
Errors in treatment therapy is another risk factor that occurs frequently, resulting in patients coming back to the hospital. The biggest treatment therapy culprit associated with hospital readmission is medication. Will may experience side effects from the new medication that require medical attention. He could also overdose on the medications due to not understanding how to take new medications or by having more than one prescription for the same medication. His caregivers may have also failed to give him the prescriptions he needs to get his medications. This risk factor has implications beyond just readmission, since incorrect administration of medication can potentially lead to Will's death.
Failure to communicate details of the hospitalization to the patient's PCP is another rather common cause for hospital readmission. The biggest problem in this area is usually the lack of communication about tests and results that were run during the hospitalization. This can potentially cause needed treatments to not be rendered or to be repeated, which can cause a patient to be readmitted, be disabled, or die. For example, let's say that Will was in the hospital and the attending physician ordered tests to check for blood clots. Before test results were received, Will was discharged from the hospital. The test results come back positive for blood clots. If the PCP is not aware of this then Will would not get the needed treatment. If he doesn't get treatment, then the clot could reach his brain, resulting in a stroke and possibly death.
Patients may experience complications after procedures that were done during the hospital stay. Some complications can be so severe that they require medical attention and present a risk factor for Will returning to the hospital. This particular risk factor is another one that could result in Will's death. Some potential complications to procedures are internal bleeding and improper healing.
The last category of risk factors has to do with situations that may come up prior to Will's discharge. Hospital-acquired infections, patient falls and bed sores could result in hospital readmission. Here's what this may look like. Our patient, Will, is in the hospital due to having a heart attack, but contracts pneumonia while in the hospital. The symptoms may not really show up until after discharge and the health care team isn't looking for pneumonia since it has nothing to do with the heart attack. Will ends up back in the hospital four days later with an active case of pneumonia.
We took a pretty in-depth look at the most common risk factors surrounding patient discharge. Patient discharge is the release of a patient from the hospital. We know that patient discharge is based on discharge planning, which is a plan of action to address the needs of the patient in the hospital setting and after discharge. Here's a recap of the risk factors that we identified in this lesson:
- Premature discharge and/or inadequate support following discharge, which is discharging a patient before they reach a certain health status.
- Patient is discharged against medical advice, which is when patients refuse treatment and decide to leave the hospital against the advice of the medical team.
- Insufficient follow-up after discharge, such as not going for follow-up appointments.
- Errors in treatment therapy, such as errors in the administration of medications.
- Failure to communicate details of the hospitalization to the patient's PCP, such as tests and test results.
- Complications after procedures, such as internal bleeding and improper healing.
- Hospital-acquired infections, patient falls and bed sores, especially those that show symptoms after patient discharge.
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