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Take 'time out' for discharge, expert says
Make sure the essential pieces are in place
Health care professionals are familiar with the "time out" surgical teams take before beginning an operation. Teams check and validate vital information on each patent in order to prevent drastic mistakes.
Across the country, the operating room time out has become standard protocol, mandated by The Joint Commission for accredited health care facilities. The World Health Organization has created a safety checklist for surgical teams to follow. The challenge, of course, is to get every team member involved in the verification process, but time outs have been shown to drastically improve surgical outcomes.
Since a time out has proven effective in an operating room setting, wouldn't it make sense for case managers and others to try something similar with discharge planning? says Toni Cesta, PhD, RN.
Cesta thinks it does make sense it's proving effective in her healthcare setting. She's the Senior Vice President for Operational Efficiency and Capacity Management at Lutheran Healthcare in Brooklyn.
"The concept is to make sure the most essential pieces of discharge planning are in place before the patient leaves," says Cesta. "Things are rushed, and some things get neglected. But before you let the patient leave, you go down a checklist."
Each hospital or other health care setting, for that matter could customize its checklist and devise questions about what's important to it.
These questions could include:
Are all the necessary prescriptions filled?
Is needed equipment going to be delivered to the patient's home?
Is the next doctor's appointment already made?
Has any outpatient testing been scheduled?
What's the date of the first home care visit?
Does the patient know where to go for physical, occupational, or speech therapy? How is he or she going to get to therapy?
Going through a list of critical care items "needs to be done more than once, not just when the patient's leaving and there's drive-by discharge planning," Cesta said. "For this to be successful, you need to build redundancy and repetition into it, because patients and their care partners need to hear this more than once."
Years ago, people used to recover in a hospital. They would simply stay put until they were completely well. Now, economic and social changes have altered that scenario, with insurance companies not wanting to pay for an extended hospital stay. Patients recover in other settings, such as sub-acute centers and skilled nursing facilities, before going home.
"Everything is so accelerated," Cesta said. "The length of the hospital stay is shorter, the patients are sicker when they leave, discharge planning is more complicated. We have to say, 'Did we do everything we needed to do?" before we send them to another setting."
With a time out, the discharge process should be less hectic, she said, because people would know what to tell a patient. But one can't assume staff are actually going over a checklist with patients and their care partners multiple times. Lutheran Hospital in Brooklyn is starting to do chart audits to make sure the staff are doing a discharge time out. And the audits are becoming a part of the case managers' annual evaluation.