People usually go to the hospital to treat an illness or injury, so hospitals are typically associated with a disease, pain, and stress. Going to the hospital is linked to the fear of the unknown, concern about their own health, and loss of freedom and familiar surroundings.
In times of the COVID-19 pandemic, many people are concerned and afraid about both being hospitalized and leaving the hospital and going home.
So, there is most likely an impatience to get out and continue recovery at home when you are already in the hospital. However, you may also feel anxious and worried about being discharged from the hospital and feel a sense of uneasiness about continuing your recovery at home.
The way this transition is handled (whether you are discharged to home or some other type of facility), is essential to your health and well-being when you are moving to the next level of care.
The following information should help you understand the hospital discharge procedures and assist you in your post-hospitalization recovery.
What Does “Discharge from the Hospital” Mean?
Discharge from a hospital involves a process of leaving the hospital after the treatment. You will be discharged from a hospital when you no longer need to receive inpatient treatment for your illness or injury. Nevertheless, your hospital discharge does not mean that you are fully healed or recovered. The hospital may discharge you to send you to another type of inpatient facility, or you may have to continue treatments at home.
After being discharged from the hospital, many people still need attention and care at home. A discharge planner at the hospital will coordinate the care you will need after you go home. They will provide the information on your illness or injury and inform you about the next steps to take, such as which medications you will need to take or how to care for a wound, for example.
The fundamental elements of a discharge plan involve:
- Evaluation by qualified professionals
- Discussion with the patient (or his/her representative) about his/her condition, types of care needed, information on meds and diet, etc.
- Planning for home care or transfer to another facility
- Determining whether caregiver education is needed
- Arranging for the follow-ups
- Referral to an appropriate home care agency or other relevant support in the community.
Who Discharges Patients from the Hospital?
When you no longer need inpatient treatment, you will be discharged from the hospital. Many hospitals have discharge planners or coordinators who help with the discharge process, coordinate the information, and help you find caregiver organizations in the community.
While only a doctor can authorize your release from the hospital, the actual process of discharge planning can be carried out by a nurse in charge, discharge planner, social worker, case manager, or other professionals. Typically, discharge planning involves a team approach.
Before you are discharged, you should be given a copy of a discharge assessment of how you should manage day-to-day activities and whether you need more care after you leave the hospital. This assessment usually is carried out by an occupational therapist or a social worker in the hospital.
Other professionals that are usually involved in the hospital discharge process are:
- Discharge consultant – they decide whether you are well enough to leave the hospital and what medical care you might need after going out
- A nurse in charge – they are supervising the care you receive and overseeing plans for your hospital discharge
- A pharmacist – they provide the medication you should be taking and give information on how and when you should be taking the prescribed meds.
In specific situations, in your discharge, may also be involved other professionals working at the hospital, such as a hospital social worker, speech and language therapist, community psychiatric nurse, physiotherapist, dietician, and others.
What are the Types of Discharge in the Hospital?
If you need little or no care after leaving the hospital, your discharge is called a minimal discharge.
If you need additional specialized care after your discharge from the hospital, this type of discharge is called a complex discharge. If you need complex care, you will receive a care plan with the details regarding your health and social care needs, such as the following:
- The treatment and support you will receive after you are discharged from the hospital
- How often treatment or help will be provided
- Who will be responsible for providing treatment or support
- Contact information for the person providing treatment or support
- How the treatment will be monitored
- The contact person if there is an emergency
What Happens If You Leave a Hospital before Discharge?
You cannot be kept in the hospital against your will. The hospital can be liable for “false imprisonment” if hospital staff and officials attempt to prevent you from leaving before hospital discharge.
However, it would be best to discuss your condition and reasons for wanting to leave before discharge with your doctor before leaving the hospital. If you decide to leave the hospital without your physician’s approval, the hospital cannot keep you against your will.
The exception is mental health patients for whom leaving the hospital before discharge may place them or other persons at risk of harm.
If you are not satisfied with the hospital, talk to your physician, and request to be transferred to another hospital.
If you try to leave the hospital on your own, the nurse in charge and the hospital administrator will urge you to stay. The hospital staff must attempt to make you follow medical advice, but if you insist on leaving, they might ask you to sign an against-medical advice form (AMA form).
The AMA form states that you are leaving the hospital against your doctor’s advice and that you release the hospital from any liability for damage caused by leaving the hospital before discharge.
You don’t have to sign this form, though. When leaving the hospital before discharge, you should write a letter explaining your reasons for leaving the hospital. You should give one copy of this letter to the hospital administrator, and keep one copy.
Can You Walk Out of ER without Being Discharged?
Yes. You can walk out of the ER without being discharged. For example, you may come to the ER and find every bed filled, the staff running around, and face hours of waiting in the emergency waiting room. If you feel overwhelmed, you can simply leave without being discharged.
It is normal to feel concerned about catching something else in the ER waiting room, especially in these days when a coronavirus may infect every person you meet.
If you don’t want to wait for hours, you are free to consider other places where you may get help. The emergency room staff may ask you to stay, but they cannot keep you in the ER against your will.
What Happens if You Leave ER without being Seen?
People check-in ER and leave before a physician can see them for many reasons.
Some people leave after the nurse’s triage, convinced that they are already feeling better or that their condition is not that serious. When a nurse tells you that your condition is not urgent, this still doesn’t mean you should leave the emergency room without seeing a physician. The purpose of the ER triage is to assign priority, so you should stay and wait for your treatment.
Leaving ER before you see a physician is not an only health risk. Leaving the emergency room unseen can also compromise your health insurance, so it is wise to wait for a physician to attend to you.
How Can I Prevent Early Discharge from the Hospital?
Extended hospital stays are less and less common today. Factors such as innovations in health care that speed recovery, pressure from insurance companies to keep costs down, and availability of online procedures and tests have considerably shortened hospitals’ stays.
Most patients are discharged from the hospital when they are clinically stable and ready to continue recovery at home or in other facilities (rehab, nursing home, etc.); however, many patients are discharged from the hospital before they are ready to go. The more unstable people are when they leave the hospital, the greater are chances that they will need to come back, or, unfortunately, die.
While health providers should monitor your unstable vital signs, you should also pay attention to any undiagnosed symptoms and consider some critical questions such as: “Am I able to take self-administer medications?” “Am I able to take care of my basic needs?” “Do I have any new symptoms?” “Do I have uncontrolled pains?”
If you are unsure whether you should go home, most likely, you shouldn’t. If you feel anxious about leaving the hospital, take a few steps before discharge.
You need to have an understanding of the next steps after you leave the hospital. “Will I need in-home care?” “How will I find a caregiver?” “Am I able to perform activities of daily living (ADLs) such as bathing, grooming, dressing, or getting around independently?” “What type of care will I need after I am discharged from the hospital?”
If your discharge is complex, ask for a care meeting before you leave the hospital, as this is an excellent opportunity to address your concerns and ask questions. A care meeting can help clarify what is going on and what kind of support you will need after the discharge
If you feel for any reason that you are being discharged too early from the hospital, share reasons why you need to stay and inform the medical team in writing why you disagree with early discharge.
Make sure you have answers to all your questions before you leave the hospital. If you need 24-hour care, you may have to go to a nursing home or seek home health care.
Home health care involves medical care that you receive at your home. Home health care covers various health care services that you can receive for an illness or injury after leaving the hospital. While home health care’s primary goal is to help you with a disease or injury, home health care also aims to help you live independently for as long as possible.
Can You be Discharged from the Hospital on a Weekend?
Yes, you can, but this is rarely the case. Most hospitals discharge patients during the weekdays. Research finds that people discharged from the hospital on the weekend are nearly 40 percent more likely to be back on Accident and Emergency within a week. Discharges from the hospital rarely take place over the weekend.
In some cultures, there is even a belief that leaving the hospital on Saturday is bad luck and will mean early readmission to the hospital.
How Do I Appeal a Hospital Discharge?
If you believe that you are being discharged from a hospital too early, you can appeal to hospital discharge. You can contact the Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO) for an immediate review of your case.
You may be able to stay in the hospital while the review lasts because the hospital cannot force you to leave before the BFCC-QIO’s decision.
Suppose Medicare covers your hospital services. In that case, you should receive a notice called the Important Message from Medicare during your hospital stay, which lists the BFCC-QIO’s contact information. This notice also explains your rights, such as:
- The right to get all medically necessary services at the hospital
- The right to be involved in any decisions about your hospital treatment
- The right to get the services you need once you are discharged from the hospital
- The right to appeal a discharge decision
- The steps for appealing the decision
You may also have the right to ask for a fast appeal if you believe that your hospital services are ending too soon. However, it would help if you asked for a fast appeal no later than the day you are scheduled to leave the hospital. This allows you to stay in the hospital while you wait for the BFCC-QIO’s decision. You will only have to pay for applicable coinsurance or deductibles past the hospital’s original day to discharge you.
Can Paramedics Make You Go to the Hospital?
No, they cannot. Emergency personnel can encourage you to go to the hospital, ask questions, listen, and reflect; however, it is your right to decide whether and how you will get to the hospital.
What does Fast Track Discharge Mean?
A fast track discharge plan is for patients with a rapidly deteriorating illness who may be entering a terminal phase.
The aim of fast track discharge from the hospital is to transfer the patient to a preferred place of care, provide support for family and caregivers, and enable a peaceful death in the preferred place.
- Fast track discharge from the hospital involves five steps:
- Communication and anticipatory care planning
- Symptom control and 24-hour care needs
- Immediate discharge
What Does Fast Trach NHS Mean?
The National Health Service (NHS) fast track funding process allows you to obtain funding to cover the full cost of your loved one’s care in place within 48 hours. NHS Continuing Healthcare Fast Track funding is for patients with a rapidly deteriorating health condition.
NHS fast track funding applies to individuals with a rapidly deteriorating illness that may be entering a terminal stage.
What is the NHS Two-Weeks Rule?
As of April 1st, 2010, you have the urgent two-week referral right.
The two-weeks rule means you your doctor urgently refers you to a specialist. You will be offered an appointment with a hospital specialist within two weeks of your physician making the referral. You have a legal right to be seen by a specialist within this timeframe, but the NHS must provide you with an alternative appointment if this is not possible.
However, you will need to ask the NHS to do this for you. If they do not offer you an alternative appointment within two weeks of seeing your General Practitioner, you need to let your GP know.
You will be urgently referred if your GP feels that you have symptoms that require a further check by a hospital specialist as soon as possible so that your condition can be diagnosed and treated faster and more effectively.
Your GP may arrange your appointment while you are with them. You will receive a printed copy of your referral and appointment details. If it is not possible to book a direct appointment, your GP will walk you through the next steps.
If you cannot make it or miss the appointment, you should contact your GP as soon as possible. Suppose you cancel or do not attend your appointment. In that case, you will no longer be covered by your urgent two-week referral right described in the NHS Constitution (although the hospital might do their best to make you another appointment as soon as possible).