SURG-Patient Discharge_McGroarty.pdf

Surgical Post-Operative Management: Hospital Discharge February 9, 2024 Carrie McGroarty PA-C, MPAS WPP Plastic Reconstructive Surgery Instructional objectives 1. Discuss the steps of the discharge process. 2. Explain the patient goals that must be met prior to patient discharge. 3. Discuss the impo...

Surgical Post-Operative Management: Hospital Discharge February 9, 2024 Carrie McGroarty PA-C, MPAS WPP Plastic Reconstructive Surgery Instructional objectives 1. Discuss the steps of the discharge process. 2. Explain the patient goals that must be met prior to patient discharge. 3. Discuss the importance of patient education prior to discharge including: a. Diet b. Activity instructions c. Wound care drains d. Rehabilitation services (eg. PT/OT) e. Coordination of follow-up appointment(s) f. Return precautions GOALS For Our Patient For Hospital Discharge generally need to be eating and drinking on their own symptom free (no N/V or bloating) with eating and drinking Tolerating diet without nausea, vomiting or bloating NGT removed Return of bowel function (positive bowel sounds and passing flatus) clamping can also lead to emesis due to increase esophageal pressure - so there are some negatives flatus = return of bowel function BM can still occur with a blockage since stool was already past site of blockage - so flatus is more helpful Pain controlled off of IV opioids Ambulating Able to complete ADLs (Activities of Daily Life) No active problems or complications cannot go home with IV pain medications - must tolerate oral pain medication cooking brushing teeth bathing walking Discharge Process Discharge planning Develop individual plan for discharge based on services required by patient up d/c Hospital case worker Start early in admission Identify patient has met goals for hospital discharge Discuss plan in detail with patient Perform Medication Reconciliation Review med changes since hospital admission Provide patient education on new meds/updates Discharge Summary Document communicates hospital course/outcomes to outpatient providers Patient Instructions for care and follow-up Medical legal document Discharge Summary Documentation Patient name/ID number/date of note Date of Admission Date of Discharge Admitting Diagnoses Discharge Diagnoses Attending or Ward Team Surgical procedures/Diagnostic tests/invasive procedures done while hospitalized (include dates) Discharge Summary Documentation Brief History & Pertinent physical exam & laboratory data Course of patient’s disease until they came to hospital & at time of admission/surgery Include PMH, PSH, Med details, Allergies, pertinent social and family Pertinent physical exam (heart, lungs, pertinent system) lab values/study results upon admission Hospital course – day by day progress Start with admission Include procedures Brief summary of daily progress note Evaluation, labs, treatment, outcome of treatment, meds Should be thorough but concise Discharge condition Discharge Summary Documentation Disposition – to where? Who will take care of patient? Discharge meds – in detail Discharge instructions & Follow-up care Diet, activity instructions, wound care, other services (PT/ OT), follow-up appointment, when to call MD/PA Document any pending tests that need to be followed up on Problem list: all active & past medical problems (include current surgery) Copies to be sent to…. Signature Hospital Discharge Important Considerations Patient education and communication are key Medications Provide prescriptions for new meds Make sure patient does not have duplicate Rx at home Educate regarding uses and side effects Identify any tests that are pending to ensure adequate follow-up of results Communicate to patient and in d/c summary Clear communication to primary care provider (typically via d/c summary) Ensure adequate/close follow-up upon hospital discharge is scheduled with appropriate providers/ services Set your patient up for success D/C Summary Template ID Date of Admission Date of Discharge Admitting Diagnosis Discharge Diagnosis Attending Procedures Diagnostic Studies Brief HPI/H&P Hospital Course PE Discharge Condition Disposition Medications Instructions & Follow Up Problem List