Discharge Starts Upon Admission

Over and over I hear “discharge planning starts upon admission”.  This is a mantra that has been pounded into me since the first day of my current position.  There is nothing more true than that phrase.  Truly effective discharge planning starts from the moment the patient enters the hospital.

In order to effectively build a working relationship with a patient and their family it is important to become a part of their treatment team as early as possible.  This can be as simple as a quick introduction upon admission and providing the patient and family your contact information to reach you with questions.  Doing this plants the seed of a working relationship. 

Once you have been introduced into the patient’s care, you become more than a discharge planner to them.  You are a resource, someone they look to for answers and ideas, and not just someone who comes to usher them out of the hospital.  As a case manager it is important to establish yourself as an independent professional to the patients and families, and not just someone filling orders. 

Once you establish a place in the treatment team, you can begin to nourish a trusting relationship with the patient and family.  Simple contact throughout their stay and remaining available to them is what will build this.  The doctor is busy and can be difficult to reach, but the case manager needs to remain easily attainable to fill this void and answer questions when the doctor cannot be reached immediately.  Being available to the patient and family is reassuring and comforting to them, and makes you reassuring and comfortable for them to work with.

Throughout building a relationship you have done a majority of your work just by simply getting to know the patient and family.  Using simple conversation you can gather a history and establish a patient’s needs and wants without a formal and dry interview.  This helps them remain comfortable and allows you to appear genuinely interested in the patient and where they are from. 

This background combined with knowing their current medical needs allows for the formulation of the patient’s discharge plan.  Which at this point should be simple to present to them and move rather quickly as you have built a trusting relationship through early and frequent contact with the patient and their family.  Discharge planning is truly 90% relationship building and 10% actual service arranging.  Once you get a family to trust you, the rest of the planning is simple. 

You should become the constant figure that helps make sense of the chaos throughout the patient’s stay.  You become the beacon that helps them realize there is an exit from the hospital that is safe and attainable for them.  This is all accomplished by starting the discharge planning upon admission and remaining constantly recognizable to the patient and family throughout their stay.