Over the years, I have heard families bemoan that their
relative who was just readmitted to the hospital was sent home too early just a
few days ago. Are they right?
Was Gramps Kicked Out Too Soon?
First, let me say that in some instances they may be
correct. It is certainly possible that
the hospital, under increased pressure to kick folks out, may have pulled the
discharge trigger too soon. The hospital
is not always right even if their ‘discharge check list’ seemed to be in
order. Of course, patients are not
adequately represented by a check list any more than physicians’ quality can be
fairly measured in the check off, cook book method that the government and
insurance companies are now championing.
The hospital discharge check list may indicate that a
patient with pneumonia can be safely discharged home as she has no fever or
need for supplemental oxygen. However,
this patient may be 89 years old, riddled with arthritis and needs to attend to
a spouse suffering from Alzheimer’s disease.
Is she really ready for home life?
Hospitals these days are more careful than ever about
premature discharge, not so much from newfound compassion, but because they
will suffer a financial penalty if a patient is readmitted within 30 days under
certain circumstances. For example, if a
patient with congestive heart failure is sent home, but then returns 2 weeks
later with worsening heart failure, then the hospital will lose money. This has created a robust outpatient
follow-up industry with visiting nurses, physicians and social workers to try
to keep folks from coming back to the hospital, at least within 30 days. (Joke alert: The terminal phrase of the last
sentence was in jest.) I applaud this
system which serves everyone’s interests.
In the hospital, care coordinators cruise through the
corridors leafing through charts to initiate discharge planning. These are nurses who have left the wards for a
cleaner administrative function.
Although I did disparage the hospital discharge check list mentality
above, and rightly so, I have found these care coordinators to be compassionate
and understanding with regard to individual patient circumstances. They know when to bend some rules, perhaps
because they were once hands on nurses themselves.
Sometimes, a patient needs to be readmitted to the hospital
and it’s simply no one’s fault. It is a
difficult concept for many Americans to grasp that an adverse event could occur
without an individual or an institution to blame. Remember, we live in a society where folks
sued Burger King alleging the company was responsible for their kids’
obesity. I counsel families that when
we are sending their relative home, particularly when they suffer from chronic
diseases or other incurable conditions, that we do so based on what I and the
others on the team know at the time. We
are not clairvoyant. If we had this
power and knew that the patient would become more ill 3 days hence, we wouldn’t
sent him home. It’s may not be quite
fair, but would be quite understandable, to wonder if a patient who is readmitted
should never have been discharged home in the first place. There
are some patients who are so fragile, that they can tilt backwards anytime and
for very small reasons.
What we know for sure is that life and illness are
unpredictable.
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