The BC Medical Journal recently published a study showing that the rate of BC patients readmitted to hospitals within a short time after they had been discharged is well above the national average, and that Vancouver Coastal Health’s readmission rate is the second highest for health regions in the province. As a 30-year paramedic, this is not news to me. I have been called to people’s homes weeks, days, and even hours after being inappropriately discharged from hospital. There have been times in my career when I have even picked them up from the hospital to transport them home, only to find out that I could never leave them there due to obvious safety concerns. I transported them right back to the hospital again without even getting them off my gurney.
Most often this happens because discharge planning did not consider whether home is suitable for them to go back to. Too many times, a patient is discharged that cannot do stairs and their bathroom is on the next floor of the house. Or they live alone and are unable to prepare meals for themselves. Or they are unable to even get to the bathroom on their own. Family or friends have not been aware, or simply do not know the questions to ask to ensure that their loved one is coming home to a safe environment. They have relied on the hospital to cover this and they do not.
Now, as an independent health care navigator and patient advocate, I am most often called on to manage crises related to hospital discharge, which is the most important part of a hospital stay to avoid readmission. Making sure that there is a well-prepared safe and secure environment for a medically-ready patient to go to is the most important factor.
Every patient or family caregiver can take steps to contribute to a safer and more effective hospitalization and transition home.
Plan for an emergency. Gather your medical information and have it easy to find in your home. Paramedics are trained to look on or in your fridge and freezer for documentation which includes who you are, who should be contacted in an emergency, who can make medical decisions for you, your current medical conditions and medications, life-threatening allergies, and so on. Don’t assume that medical records at one hospital or doctor’s office are available to another hospital or physician. You need to have all your information ready to travel with you.
Plan for your hospital discharge if you know in advance that you are going to be admitted to a hospital. Find out what you will need in terms of medical equipment, help with medical and personal care, household help, and so on. The best way to avoid crises is good preparation.
Plan to have someone attend medical appointments with you and to be available during your hospitalization. A second pair of eyes and ears, especially someone who is good in a crisis is a big help. If you have suffered a critical illness or injury, you are not going to be at your best, so you need to authorize someone to intervene and speak for you when you can’t.
Plan for incapacity. At some point all of us will need to make medical decisions in keeping with our values and wishes. Getting a tattoo on your chest that says “No CPR” is not an effective or legal way to communicate those wishes.
Plan for death. Talking about it is not going to kill you. Make sure that you leave a legacy and not a mess for your loved ones.
These are the things that we can do to be an empowered patient. These are the things we MUST do to ensure our own well being in our fractured health care system. Because it is broken. I have seen it for years, first hand, from a pre-hospital specialist perspective. From a paramedic’s perspective.
More information can be found on our blog “Discharge Planning from Acute Care to Home or Residential Care”