Discharge, Transfer, and Postmortem Procedures



Discharge, Transfer, and Postmortem Procedures



Chapter Objectives


On completion of this chapter, you will be able to:


1. Define the terms in the vocabulary list.


2. Write the meaning of the abbreviations in the abbreviations list.


3. Discuss the purpose of patient discharge planning and patient care conferences, and identify personnel and individuals who would be involved in both.


4. List five types of discharges, and explain the importance of communicating pending discharge information and bed availability to the admitting department or bed placement in a timely manner.


5. List 12 tasks that may be required to complete a routine discharge when paper charts are used.


6. List six additional tasks that may be required when a patient is discharged to another facility and six additional tasks when a patient is discharged home with assistance when paper charts are used.


7. Describe six tasks necessary to prepare the discharged patient’s medical record for the health information management services (HIMS) department when paper charts are used.


8. Explain what the health unit coordinator (HUC) should do when a patient threatens to leave the hospital without a physician’s discharge order.


9. Explain the HUC tasks that may be required and/or requested when a patient dies, and discuss the need for the patient’s death to be verified and the time documented by a doctor or resident.


10. Discuss how the deceased patient is transferred to the morgue, and explain the possible HUC tasks related to the release of remains and organ donation.


11. Explain the usual circumstances regarding a patient’s death that must be met for the patient to be accepted as an organ donor.


12. Explain why an autopsy would be performed and list the circumstances that would define a “coroners case.”


13. List eight tasks performed by the HUC when a patient dies (postmortem) when paper charts are used.


14. List the two primary reasons a doctor would write an order for a patient to be transferred to another room or nursing unit.


15. List nine tasks that are performed when a patient is transferred from one unit to another when paper charts are used.


16. List seven tasks performed by the HUC when a patient is transferred from one room to another room on the same unit when paper charts are used.


17. List seven tasks that are performed by the HUC when a transferred patient is received on the unit when paper charts are used.


18. Discuss the importance of reading the entire set of discharge or transfer orders prior to the patient being discharged or transferred.


19. Describe additional tasks that the HUC may need to carry out to complete a routine discharge procedure when the electronic medical record with computer physician order entry is used.



Vocabulary



Autopsy


Examination of a body after death; it may be performed to determine the cause of death or for medical research purposes.


Clinical Death


State in which no brain function is present.


Coroner


A public officer whose primary function is to investigate by inquest any death thought to be of other than natural causes.


Coroner’s Case


A death that occurs because of sudden, violent, or unexplained circumstances, or a patient who expires unexpectedly within the first 24 hours after admission to the hospital (deaths investigated by a coroner).


Custodial Care


Care and services of a nonmedical nature, which consist of feeding, bathing, watching, and protecting the patient.


Discharge Order


A doctor’s order that states that the patient may leave the hospital; a doctor’s order is necessary for a patient to be discharged from the hospital.


Discharge Planning


Centralized, coordinated, multidisciplinary process that ensures that the patient has a plan for continuing care after leaving the hospital.


Expiration


Death.


Extended Care Facility


A medical facility for patients who require expert nursing care or custodial care; may also be referred to as a skilled nursing facility.


Organ Donation


Donating or giving one’s organs and/or tissues after death; one may designate specific organs (e.g., only cornea) or may donate any needed organs.


Organ Procurement


The process of removing donated organs; may also be referred to as harvesting.


Patient Care Conference


A meeting that includes the doctor or doctors caring for the patient, the primary nurses, the case manager or social worker, and other caregivers (may include family) involved in the patient’s care.


Postmortem


After death (a postmortem examination is the same as an autopsy).


Release of Remains


A signed consent that authorizes a specific funeral home or agency to remove the deceased from a health care facility.


Terminal Illness


An illness ending in death.


Transfer Order


A doctor’s order that requests that a patient be transferred to another hospital room, another nursing unit, or another facility.





image EXERCISE 1


Write the abbreviation for each term listed.





image EXERCISE 2


Write the meaning of each abbreviation listed.





Discharge Planning


Discharge planning is a centralized, coordinated, multidisciplinary process that ensures that the patient has a plan for continuing care after leaving the hospital. Discharge planning begins the moment a patient is admitted to the hospital and usually is handled by a case manager or a social worker who assist patients and their families with arrangements for post-hospitalization care. The case manager or social worker works with the patient and the patient’s family, nurses, and physician(s) in developing a discharge plan of care that is tailored to meet the specific needs of the patient. Once the plan has been developed, the case manager secures the necessary posthospitalization services and can provide information about additional community resources when necessary.


A patient care conference is a meeting that includes the doctor(s) caring for the patient, the primary nurses, the case manager or social worker, and other caregivers (may include family) involved in the patient’s care. The purpose of the conference is to review and evaluate the goals and outcomes of the patient’s recovery progress and to modify the care plan as needed. Often a patient care conference is scheduled before the time of a patient’s discharge so that a posthospitalization care plan can be developed. The health unit coordinator (HUC) should be made aware when the patient’s paper chart is taken into the conference room.



Discharge of a Patient


Once a patient’s doctor has entered a discharge order into the patient’s electronic medical record (EMR) or has written a discharge order in the paper chart, the prompt attention of the HUC is required. Most patients prefer to leave the hospital as soon as possible after the discharge order has been written. When transcribing a discharge order, the HUC would enter the patient’s name under “discharges” on the admission, discharge, and transfer log sheet (ADT log sheet) and would notify the admitting or bed placement department by telephone or computer. It is important to send or call a “pending discharge” to the bed placement or admitting department in a timely manner and to communicate when the bed is ready for another patient, especially when the hospital is full. Often there are patients waiting to be admitted, some for hours in the emergency department. Withholding notification of a discharge order will cause a delay in an incoming patient’s admission and treatment. The HUC must also notify environmental services (housekeeping) when the patient has vacated the room, so the room can be cleaned and the room and bed prepared for the admission of a new patient. This notification may be done by phone or computer. The HUC would enter the date of discharge in the admission, discharge, and transfer log book (ADT log book) next to the patient’s label (placed there when patient was admitted) with the date and type of discharge (e.g., Home, Sunset Assisted Living). The name is also erased from the nursing unit census board. This is done when using the EMR and when using paper charts.


When the EMR is implemented, the HUC may have the additional task of printing out the medication information sheets for medications that the patient will be taking after discharge.


When the EMR is used, the beds are color-coded on the computer census screen as follows:






Discharge to Another Facility


Insurance reviewers are employed by insurance companies to review hospitalized patients’ charts to advise doctors regarding what the insurance will cover and how many hospital days will be covered. Insurance reviewers are required to show identification (ID) before having access to a patient’s electronic or paper chart. When the patient no longer needs expert nursing care but still requires custodial care, the doctor is requested to transfer the patient from the hospital to an assisted living facility or nursing care home. Custodial care is care of a nonmedical nature, such as feeding, bathing, watching, and protecting the patient. The insurance reviewer places



PROCEDURE 20-1   ROUTINE DISCHARGE PROCEDURE
































TASK NOTES

The discharge order may be indicated by an icon on the computer census screen next to the appropriate patient’s name when the EMR is used or may be handwritten when paper charts are used. The order may be written on the doctor’s order sheet the day before or the day of the expected discharge. Sometimes the doctor will write an order for a chest x-ray study or other diagnostic test(s) to be performed before discharge. Check for any prescription that may have been left on the chart by the doctor.

 The patient’s nurse will provide the patient with discharge instructions.

 Notification may be made by telephone or by computer. Entering a “pending discharge” with expected departure time notifies the business department to prepare the patient’s bill. Some patients may be required to stop at the business office before leaving the hospital. The “pending discharge” notification also alerts the admitting department that a patient who is waiting to be admitted may be placed into a room slot. Holding notification of a discharge could delay another patient’s admission and the start of treatment.

 Explanation of the discharge procedure may also be given by the nurse; however, many patients come to the nurse’s station and ask the HUC for the explanation.

 Departments such as physical therapy and cardiopulmonary (respiratory care) may have to be notified. Communication may be made by telephone or by computer.
The HUC may need to cancel the patient’s food tray or order an early tray.

 Write out the appointment date and time on a piece of paper and give it to the patient’s nurse. The appointment date and time may then be written on or typed into the discharge instruction sheet.

 Patients who do not have family or friends available to provide transportation may have to have a call made for a taxi. Many hospitals provide taxi vouchers for patients.

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Apr 8, 2017 | Posted by in MEDICAL ASSISSTANT | Comments Off on Discharge, Transfer, and Postmortem Procedures

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