Doctors have noticed these trends for years. Because of insurance company pressures, we are sending patients home earlier and sicker. There is pressure not to keep a patient in the hospital very long. Are they being sent home before they are completely recovered? Possibly. Do you rest better in your own bed without someone coming in to take your temperature and blood pressure at 2 AM? Definitely!
Medicare is now keeping track of how often patients who are discharged from a hospital are readmitted, and how soon this happens. They have figured out that this costs them a lot of money. Within 30 days, one in five people are back in the hospital (20%). Within 90 days, one in three patients are back (34%). This is costing Medicare over $17 billion per year.
Some patients develop infections. Some patients have bleeding. Something happens to an incision. Something absolutely unrelated to the original problem will happen. (Since when is a broken leg related to pneumonia for example?) There are readmissions for medication problems. People end up in the ER, and back in the hospital.
Patients are leaving without really understanding what they are supposed to do when they go home. Medications may have been changed while they are in the hospital. They are unclear about which medications they are supposed to take when they get home. Here are suggestions about what you as a patient (or caregiver to the patient who is coming home) should know and do:
1. Know your diagnosis and any procedures that you had.
2. Know when you should have a follow up appointment, and who it should be with (surgeon, family doctor, physical therapy, etc.)
3. Schedule your follow up appointments ASAP.
4. Make sure your regular doctor gets copies of any and all paperwork from the hospital. If the hospital doesn’t send them, call your doctor’s office to let them know you were in the hospital so they can tell you how to arrange for records to be sent.
5. Make sure you know what medications you are supposed to be taking when you go home. Are you supposed to resume any of your previous medications? Are any of the medications you are given different names for the same medications you take at home? DO NOT LEAVE THE HOSPITAL UNTIL YOU KNOW THIS!!!!!
6. Find out what you should expect that is normal. Bruising? Aches? Swelling?
7. Find out what you should look out for that is not normal. Fever? Redness? Pain getting worse? Shortness of breath?
8. What are you allowed to do? What are you not allowed to do? Lifting? Showering? Childcare? Do you need someone with you?
9. Who should you call if there is a problem day or night?
10. If you have dressings, stitches, a cast, drains or other surgical “stuff”, ask for directions on care and cleaning. Ask about when things should come out.
11. If there are test results that you are waiting for, ask how you are supposed to find out the results.
12. Before you sign any papers, make sure you understand everything. Ask someone to explain it until you are sure you know what you are supposed to do. Don’t let anyone rush you through this process.
13. If you have questions or problems after you go home, call the hospital where you were or the emergency number you were given. We like to “head off” problems before they get big. Sometimes a simple office visit will avoid a hospital stay.
14. Bring a copy of all your papers to your follow-up appointment.
Hopefully these tips will keep you from having to go back to the hospital. As doctors, once we send you home, we want to see you well and in our clinics or offices, not back in the hospital. We hate those hospital gowns as much as you do!