Arthur Shorr (Former COO and SVP of Cedars-Sinai Medical Center) gives expert video advice on: How much notice will I get before my hospital discharge?; Can I discharge myself from the hospital at any time?; Where can I get help with questions or complaints about hospital service after discharge? and more...
How much notice will I get before my hospital discharge?
A discharge plan for your hospitalization is actually established when you are admitted to the hospital. The discharge plan is obviously tentative since much will depend on the progress you make in the hospital but an anticipated discharge date is part of the admitting process. If your doctor hasn't told you what he anticipates, you should ask him. Some insurance companies actually carry out a review of hospitalized patients' stays on a daily basis to insure that hospital stays are kept to an absolute minimum. But please understand that you cannot be discharged until your doctor determines that you are medically stable and that the hospital has worked out an appropriate discharge plan for you.
What is a 'discharge plan'?
A discharge plan is an understanding of where you are going to go, whether you are going to go home and under what circumstances and with what assistance; whether you are going to go to a convalescent hospital, or a nursing facility or some other rehabilitation environment. A discharge plan also covers how you are going to get home, who is going to assist you, what medications you are going to need, what instructions are required for you to understand in order to take care of you and when you need to see your physician again.
Can I discharge myself from the hospital at any time?
You can discharge yourself from hospital. Any adult who has the capacity to make independent decisions and healthcare decisions has the right to decide whether or not to submit to medical treatment and/or stay in a hospital. Before a patient is discharged against medical advice, if you wish to leave the hospital against medical advice, your doctor will try to communicate with you and inform you as to why the continued hospitalization is recommended and the potential consequences and the risks if you choose to live against medical advice. The doctor will also suggest any alternatives that are possible, including transfers to another hospital or out patient treatment if that possible for you. Once you notify the nurse that you want to leave against medical advice, she will contact your physician immediately, and that physician will be asked to talk to you, either in person or by telephone. If you still decide to leave against advice, you'll be asked to sign and complete a form documenting that you were given information regarding the possible risks and consequences that may result from your decision to leave against medical advice. The hospital and the physician will take reasonable steps to ensure that if you leave the hospital, you leave in a very safe manner. If the physician feels that its unsafe for you to drive, the hospital may call a taxi or arrange an ambulance at your expense to take you to your destination.
What does 'against medical advice' mean?
Against medical advice means simply that, in the opinion of your attending physician, they advise you not to leave the hospital even though you yourself wish to discharge yourself from the hospital.
What do I do if I don't want to be discharged from the hospital?
You can ask your physician to review the decision to discharge you and to consider any other information you may be able to provide to allow your stay in the hospital. You can also appeal your decision to remain in the hospital to the insurance company, if the insurance company is pushing on the physician to have you discharged. A hospital is required to have an appropriate discharge plan in place, and you may not be discharged before that plan is in place and agreed to by your physician. You cannot be put out on the street, you cannot be discharged by force. However, if your physician feels that you should be discharged, and you wish to remain in the hospital, you will be liable for any hospital charges that occur after the insurance company, or the hospital, based on your physician's recommendation, concludes that your hospitalization is no longer necessary and your doctor feels you are stable for discharge.
What information will I receive about my hospital discharge?
Prior to your discharge, your doctor will review his expectations with you. For example, what he expects you to do while you're at home; when he expects to see you in his office. He will advise about what medications to take, what kind of care you will need over the next few days or weeks, immediately before your discharge. A nurse will sit down and discuss the discharge process to make sure you have a complete understanding of your physician's discharge instructions. Usually, the discharge process will occur in the presence of another family member or some care-giver to allow someone else to listen to the instructions, because sometimes it's very hard as a patient to hear and truly comprehend the instructions during the discharge process. To even further make it meaningful to you, you will be handed a copy of written discharge instructions, which reflect that which the nurse was teaching you during that discharge process. The nurse will also educate you about what signs and symptoms to be sensitive to. That should occur before you see your physician.
Where can I get help with questions or complaints about hospital service after discharge?
Where to get help about discharge queries really depends on the types of questions or complaints you have. If you have not been injured but believe you were treated rudely, write or call the hospital administrator. If you feel you've been injured as a result of negligence by your doctors or by hospital employees, you should contact an attorney who specializes in medical malpractice.
Why is it important for a patient to fill out a 'hospital survey'?
Most hospitals will send a patient a survey questionnaire to help the hospital understand how the patient understood and experienced their hospital stay. It's very important for a patient to fill out a hospital survey because this is the only way the senior administration can really appreciate how you, a specific patient, in the context of your medical needs, was taken care of and treated in the hospital. All surveys are compiled into statistics to help identify areas of the hospital that need improvement, and areas in the hospital that are actually complying with the expectations of the governing body and the administration. A discharge survey allows the hospital to identify areas that need additional improvement, all of which is designed to improve patient stay, patient comfort, and actually maximize patient safety.