Future Leaders Communiqué Volume 3 Issue 3 July 2018
Download PDF: FL Communiqué July 2018
Case: Too sick to go
Case: Safety netting at discharge
Comments from our peers
Listen to your patient
It’s not always about the job
It is my pleasure to welcome you to this issue of the Future Leaders Communiqué. We will reflect on two cases where pressured discharge planning sadly preceded tragic outcomes.
Many of us will share in the experience of a busy day in hospital, being pulled in multiple directions for competing tasks, including discharging patients. Completing an effective discharge can be time consuming and complex. Managing this process while picking up patients from a busy emergency triage, or while keeping up with a ward round, or juggling pagers, is not always easy. Despite our best multi-tasking efforts, this is a process that is often rushed and without adequate access to support.
Reflecting on my own experiences as a junior doctor, this task was often given lower priority than it deserved. I can recall chasing after my senior consultants on a ward round, taking notes, requesting investigations, and responding to nursing staff concerns as we moved from patient to patient. As was often the case, my team would instruct the patient that they were ready for discharge and we would give them a script for their new medications before moving on to the next room. Later, I would return to the ward to hurriedly complete a discharge summary and follow-up referral details, before clinic began for the afternoon.
Inadequate discharge planning has the potential to disrupt continuity of care, and increases the likelihood of adverse events. Junior doctors must fast become skilled in this process to optimise patient outcomes. A 2016 Cochrane review of 30 randomised controlled trials identified that effective discharge planning resulted in a small reduction in length of stay, and reduced the risk of readmission in older people with a medical condition. The reviewers concluded that individualised discharge planning may also increase patient and healthcare provider satisfaction (Goncalves-Bradley DC et al, 2016).
So what makes up an individualised discharge plan? A BMJ article titled ‘Planning a patient’s discharge from hospital’ identifies good planning to involve information gathering, resolution of discharge barriers, early referral to the multidisciplinary team and collaboration with the patient and their family. This article also highlights that “the junior doctor is often an important coordinating link in the process of discharge” (Katikireddi, 2008).
When I first read the following two cases, I was very aware that I had been involved in the care of many patients with presentations just like Mrs JC and Mr MN. Neither of these patients suffered rare or complex illnesses, and in each of these cases small components of discharge planning, done properly, could have made all the difference. For junior doctors, these cases act as a reminder to use discharge planning to safeguard against adverse outcomes, even after patients have left our care.