Discharge Process

 

 

 

Patient Discharge

A. Purpose

  1. To provide criteria and procedures involved in the patient discharge process with an aim to minimize the time involved in the process in order to increase patients’ comfort and satisfaction.
  2. To guide the healthcare team in evaluation, individualization, and follow-up of a patient’s discharge-related needs during and after admission. To define the policies for patients leaving the hospital against medical advice.
  3. To have a mechanism for L.A.M.A. & Discharge On Request (DOR) patients.

B. Scope

Applicable to patients getting discharged from SMVS Swaminarayan Hospital and Research Foundation, Gandhinagar.

C. Responsibility

The responsibility of overall implementation of this policy is with medical officers, nursing staff, IP coordinators, pharmacy staff, billing executives, assistant managers of operations, and heads of operations and medical services.

D. Definition

Nil

E. Abbreviation

Nil

F. Distribution

Patient Care Areas, Pharmacy and Billing

G. Policy

  1. The discharge process is planned in consultation with the patient and/or family and in coordination with various departments.
  2. The patient has the right to leave the hospital against medical advice.
  3. The hospital has to follow the immediate following guidelines for L.A.M.A./DOR.

H. Procedure

  1. Discharge planning is a multidisciplinary, collaborative process involving the patient, the patient’s family, and concerned team members during a specific episode of illness.
  2. Discharge planning is to be initiated on the basis of the patient’s condition by the consultant before the planned time of discharge.
  3. Assessment of the patient is to be made for being ‘medically stable’ and fit for discharge. This may include assessment of functionality, medical condition, medications, psychological condition, and/or cultural needs as well as oral surgical point of view.

H.1 Discharge planning involves several activities:

  1. Development of a care plan for post-discharge of the patient.
  2. Arranging for the provision of services, including patient/family education and referrals.
  3. The nurse in charge as well as the medical officer is responsible for coordinating the discharge with other team members.

H.2 Discharge Summary will contain:

  1. Reasons for Admissions
  2. Significant Findings
  3. Final Diagnosis
  4. Patient’s Condition at the time of discharge
  5. Investigation Results (Critical/Abnormal Values)
  6. Any Procedure performed
  7. Medication Administered
  8. Other Treatment Given
  9. Follow-up advice, medication, diet, physiotherapy consultation
  10. Instructions about how and when to obtain urgent care

Each patient will be provided with a discharge summary on the day of discharge. The original copy of the discharge summary is given to the patient, and another copy of the discharge summary will be kept in the patient’s medical record.

H.3 Discharge Process

  1. In the morning round, the consultant has decided on the patient’s discharge/transfer in their respective areas. After that, MO has started preparation of the discharge summary of the patient. Simultaneously, the unit nurse has started preparation of the patient file.
  2. The unit nurse checks all medications that are not used by the patient on the discharge day. The pharmacy return by the unit nurse sends spare medications & drugs to the pharmacy. The pharmacy department will clear the return issue of medicines and give final approval.
  3. The unit nurse will arrange the file with completed documents.
  4. The file is then sent to the pharmacy department for pharmacy clearance.
  5. After the pharmacy clearance, the file is then sent to the billing department for final billing & clearance.
  6. The billing department will do the audit of all bills during the hospitalized period. The final bill is then approved by the Head of Operations and Medical Services. Once the final bill is approved, it is then intimated to the patient/relatives for bill settlement. The billing department will generate the patient’s final bill slip after clearance of the outstanding amount.
  7. Then the patient’s relative will be given a discharge authorization slip and will be sent to the nursing station.
  8. The patient’s relative will give this final slip to the unit nurse. The MO & unit nurse will explain about discharge medication to the patient and/or relative. The ID band is removed from the patient’s wrist. The patient will be physically discharged from the unit. Then, the patient is physically discharged.

H.4 In case of Government Schemes and TPA Patients

  1. After pharmacy clearance, the file is sent to billing for audit and final clearance. The billing department will do the audit of all bills during the hospitalized period. After the audit, the file is sent to the Government Scheme desk or the TPA desk for billing.
  2. The government scheme desk or TPA desk does the final billing as per the services availed, hospitalization period and pre-authorization obtained from the respective company or organization.
  3. The bill is then sent to the billing desk for final settlement.
  4. The billing department will generate the patient’s final bill slip after clearance from the Government Scheme desk or TPA desk.
  5. Then the patient’s relative will be given a discharge authorization slip and will be sent to the nursing station.
  6. The patient’s relative will give this final slip to the unit nurse. The MO & unit nurse will explain about discharge medication to the patient and/or relative. The ID band is removed from the patient’s wrist. The patient will be physically discharged from the unit. Then, the patient is physically discharged.

H.5 In case of LAMA (Leave Against Medical Advice)

  1. The relative will inform the consultant/medical officer of their patient’s willingness to get Leave Against Medical Advice.
  2. MO will inform the deputy medical administrator regarding the same. The Deputy Medical Admin/Assistant Nursing Superintendent (as per requirement) will counsel the patient’s relatives to confirm the reason for LAMA and will inform to Head Operations and Medical Services.
  3. Then the Consent for LAMA/DOR form is filled by the patient.
  4. Once discharge is confirmed, information will be provided to the Registrar/MO for the file preparation.
  5. Meanwhile, the staff nurse will prepare the patients’ file.
  6. The treatment summary will be attached to the patient’s discharge file and will be sent to the billing department.
  7. Till that time, the pharmacy department will clear the return issue of medicine.
  8. The patient’s file will be sent to the Billing Department. The billing department will collect the payment and do the audit of the bills.
  9. IP Coordinators will arrange any special requirement of the patient, i.e., an ambulance, etc., upon request.
  10. The patient’s relative will give the final bill authorization slip to the nurse, and the nurse will explain about the discharge medication.
  11. The patient will be physically discharged as per the previously explained discharge procedure.

H.6 In case of Medico-Legal Case (MLC)

  1. The attending consultant order for discharge is given to the MO.
  2. The MO informs regarding the patient discharge to the respective Police Station. MO prepares the patient’s discharge summary.
  3. 2 copies of all the patient’s reports will be taken; both copies will be kept in the medical records department, and the second copy can be sent to the police station if required for legal purposes. The discharge summary will be attached to the patient’s discharge file and will be sent to the billing department by the staff nurse.
  4. Till that time, the pharmacy department will clear the return issue of medicine.
  5. The billing department will collect the payment and do the audit. Then the patient’s relative will be given a discharge authorization slip.
  6. The patient’s relative will give the final bill authorization slip to the unit nurse, and the nurse will explain about discharge medications.
  7. The patient will be physically discharged.

H.7 In case of Death

  1. The cause of death will be mentioned in the Death Summary.
  2. In case of death in a medico-legal case, the discharge diagnosis will be as per the autopsy report.
  3. Death cases will be reported to the assistant manager of operations on a regular basis by the MRD person or ANS for future legal proceedings.