New Moves

To help hospitalists understand how surveyors approach this process, the following summary provides information about the two review options.

Discharge Planning—Active Review

1. Ask for a list of patients who will be discharged during the survey.
2. Review the patient’s medical/clinical record for discharge orders.
3. Request that the organization obtain patient permission to observe the discharge process.
4. Observe the clinician providing discharge instructions. Components of the discharge instruction may include:
   • Activity;
   • Diet;
   • Medications (post-discharge);
   • Plans for physician follow-up;
   • Wound care, if applicable;
   • Signs and symptoms to be aware of (i.e., elevated temperature, medication side effects);
   • The name and telephone number of a physician to call should a problem or question arise following discharge; and
   • Patient repetition of information to confirm understanding.
5. Review the written discharge instructions given to the patient. The discharge instructions are written in a language the patient can read and understand.
6. Interview the patient to determine the patient’s level of understanding of discharge instructions. If applicable to the instructions given to the patient being observed, the patient should understand:
   • The purpose for taking any new medication;
   • How to take the medication, including dose and frequency;
   • Possible side effects of medication;
   • The medication regimen, including continuation or discontinuation of medications taken prior to hospital admission;
   • Contraindications between prescribed medications and over-the-counter medications and herbal remedies;
   • Changes in diet and dietary restric- tions or supplements;
   • Signs and symptoms of potential problems and who to call with questions and concerns;
   • Information regarding continued self-care (i.e., wound care, activity);
   • Follow-up process with physician(s); and
   • Arrangements made for home-health needs (i.e., oxygen therapy, physical therapy).
7. Interview the nurse/clinician to ascertain the origination of discharge information (physician-nurse communication regarding discharge instruction).

Discharge Planning—Retrospective Review

1. Ask for a list of patients discharged during the past 48 hours.
2. Review the patient’s old medical record for discharge orders.
3. Request that the organization stay with the surveyor as phone calls are made. The organization should first talk with the patient to explain the purpose of the call and obtain permission for a phone interview.
4. Interview the patient to determine understanding of discharge instructions provided. If applicable to the instructions given to the patient being observed, the patient should understand:
   • The purpose for taking any new medication;
   • How to take the medication, including dose and frequency;
   • The medication regimen, including continuation or discontinuation of medications taken prior to hospital admission;
   • Possible side effects of medication;
   • Contraindications between prescribed medications and over-the-counter medications and herbal remedies;
   • Changes in diet and dietary restrictions or supplements;
   • Signs and symptoms of potential problems and whom to call with questions and concerns;
   • Information regarding continued self-care (i.e., wound care, activity);
   • Follow-up process with physician(s); and
   • Arrangements made for home health needs (i.e., oxygen therapy, physical therapy).
5. Explore the patient’s perception of the discharge instructions. Does the patient believe the necessary information was given?