The day of discharge is the most important day in the patient's hospital stay. Although it may appear straightforward to the patient, there are many procedures that have to be completed before the patient can leave.
The day of discharge is usually decided 24 hours before, and the decision is made by the physician in charge of your case. He or she is the only person authorized to discharge you. All your questions should have been answered, and you should be fully aware of the outcome of your hospital stay and the type and degree of activity in which you can involve yourself.
Some hospitals have printed sheets of instructions for patients convalescing from common disorders or operations. The physician usually discusses all of these subjects with you the day before you are discharged from the hospital. After this discussion, the physician has to go to the nursing station to review your hospital record. The physician does this every day in order to see any new test results or to read the nursing reports or medicine orders.
On the day before discharge, there are additional items that require his or her attention. The order for discharge and the date of discharge have to be written on the record. The physician will have to check that a careful record has been made of the medication which the patient needs to continue taking at home and that a prescription for these drugs has been written. The physician must also add a final diagnosis or diagnoses on the face sheet of the record, and dictate a summary of all that has happened during the hospital stay. This latter piece of information may be compiled by the resident physician and may be done a few days after you have left the hospital. It is an important part of the procedure, particularly if another physician is taking over your care during convalescence at home.
The summary reviews your complete case, records the results of all the tests, describes any surgical or diagnostic procedures, states what medication you were given or may still be taking, and what treatment you were given while in the hospital. If any tissues have been removed from the body, they are sent for microscopic examination by a pathologist, and the summary includes the pathologist's report. IF you received a blood transfusion during your stay, this is also recorded on the summary, a copy of which is sent to your family physician to become part of your personal medical record.
Until the discharge order is written and signed, no patient can legally leave the hospital or be released by another member of the staff. Once it is signed, other people on the unit continue the discharge procedure.
The ward clerk will notify the cashier's office, and in many hospitals the information is passed through a computer so that all areas of the hospital know which patients are being discharged. This includes the information desk, finance department, and the medical records department.
On the day of discharge all of the materials involved in your medical care are assembled by a nurse who checks that the records are complete before sending them down to the medical records department after your release.
The ward clerk usually asks you what time you will be leaving and also informs you of the hospital policy for the time of departure.
On the morning of discharge, pulse, respiration, and temperature are recorded as usual, as an additional safeguard. If a patient has even a slight temperature, he or she may not be discharged. This precaution is necessary to prevent complications after the patient has gone home.
A member of the nursing staff makes sure you have a prescription for medication, which you can collect from the hospital's pharmacy. Once at home, you should make use of a local pharmacy for refills. The nurse will check that the prescription is correctly dated and signed. The physician may have left instructions for the administration of medication before you leave the hospital. Any drugs left on the medicine cart in your name are returned to the pharmacy.
A nurse on the unit will help you to dress if you cannot manage on your own. You will then be asked to wait in your room until someone comes to help you down to the hospital entrance. Even if you are feeling healthy and fit, you will be asked to sit in a wheelchair for the journey. Many hospitals have a risk management expert who is employed full-time to transport patients. This is a wise precaution for many reasons. Even if your hospital stay was short and the condition or operation minor, you will certainly have spent more time in bed than usual. Because of this, your muscles will be temporarily weaker. You may find that after a walk to the elevator and a standing wait, you feel weak and dizzy. You may even faint.
You are taken in the wheelchair to the main lobby where you can collect your valuables from the cashier's office and sort out details of payment. For weak patients, a member of the security department will deliver valuables to the room.
Discharge Against Medical Advice. Occasionally, a patient discharges himself or herself against the advice of the physicians. In such an event, the patient must sign a form confirming that the action being taken is against medical advice (known as A.M.A.) and that the hospital and medical staff concerned cannot, therefore, be responsible for anything that happens afterwards. A.M.A. is obviously a dangerous practice. The reason is often dissatisfaction about the care you are receiving. If this is the case, it is safer to ask for another physician to take over your case than to leave the hospital against advice.
Hospitalization - Admission Procedures
The procedures you follow on admission to a hospital vary from one hospital to another, but basically the process is the same in most institutions in the United States.
Care of the Dying - Reaction of Children
A child's reaction to death depends on many factors. A child's first experience with death is often the death of a pet. A child under the age of eight cannot understand that death is irreversible and may expect the mother or father to bring the pet back to life. After the age of eight or nine, the child's understanding is usually as rational as an adult's understanding.
Care of the Dying - Moment of Death
Do not be alarmed if the patient's breathing makes a groaning or croaking sound. It does not mean that he or she is in pain. When a dying patient slips into a coma, the position of the neck and body produces the noise, which can be reduced by gently turning the patient's shoulders or body.
