Understanding and preventing unsafe hospital discharges

It’s today’s reality: Healthcare systems—and their professional caregivers—are under pressure to provide flawless services while simultaneously reducing costs. This conundrum is making more healthcare facilities find more efficient ways to discharge patients in a safe and coordinated manner. 

Countless patients nationwide are regularly being discharged from hospitals before they are medically stable. This should signal alarm bells. 

Without the proper follow-up instructions or medications, a successful patient recovery may not be possible. Unsafe discharges result in a large number of preventable hospital readmissions. Not only this, but negligent discharges can have devastating effects on the patient's health and a plethora of legal liabilities for the medical facility in question. 

So, what is an unsafe hospital discharge, and how can they be prevented? 

Here’s a breakdown of considerations and strategies for preventing unsafe hospital discharges that can put your patients and facility at risk. 

What would be considered an unsafe hospital discharge?

Understanding what constitutes an unsafe discharge from your hospital and why it can happen can save your facility from unwanted legal actions. Being familiar with unsafe discharge actions will also help you protect patient safety. 

The following cases are typically considered unsafe hospital discharges:

• Premature or untimely discharge: Releasing a patient before they are medically stable or have fully completed their treatment
• Inadequate post-discharge care: Releasing a patient without the necessary information, instructions, or medication to continue treatment
• Poor communication from the medical team: A discharge without patient and caregiver involvement in discharge planning, such as being informed of the patient's condition, treatment plans, etc.
• Negligence: Straightforward negligence by doctors and other hospital staff 

What are the risks of unsafe hospital discharges?

Unsafe hospital discharges can have many consequences, not only for the patient's safety but also for the medical center in question.

• For the patient, a wrongful discharge can result in a worsening of symptoms and their medical condition that can lead to readmission in the medical facility and could also result in permanent health conditions and even death. For example, early discharge risks include increased probability of infection and medication management issues.

• For a medical facility, a premature patient discharge may lead to legal consequences, such as a malpractice lawsuit. Patients may also leave against medical advice (AMA). When patients leave AMA, they are more likely to die or be readmitted within 30 days. Plus, readmission can result in higher and avoidable healthcare costs. 

Another consequence of unsafe discharges may result in a poor Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) score. The HCAHPS scores, also known as the CAHPS Hospital Survey, are a standard for patient satisfaction measurement. Ultimately, poor discharge experiences can negatively impact these scores, reflecting broader issues in care coordination and patient communication.

Common types of unsafe discharges

While unsafe discharges may occur unintentionally, most are avoidable. 

Here are the most common reasons why unsafe discharges occur: 

• A high patient census and occupancy, creating pressure to free space in the hospital for incoming patients
• An understaffed medical team, making it difficult for facilities to prioritize care for patients 
• Miscommunication between different members of the medical team, creating confusion and inadequate support for the patient at the moment of discharge
• Financial pressures, such as the ever-present pressure to reduce costs and insurance policies pushing facilities to shorten hospital stays

Legal and ethical considerations in discharge decisions

Specific hospital discharge protocols, governed by federal and state laws, aim to protect patients from being released too early or without proper planning.

For instance, the Centers for Medicare and Medicaid Services (CMS) is, in their own words,  “committed to ensuring that the health and safety of patients are protected when discharges from hospitals and transfers to post-acute care providers occur.”

Can hospitals be sued for an unsafe discharge?

Yes, an unsafe discharge can be considered medical malpractice; your hospital could be sued for negligence if you fail to ensure a proper discharge. Patients deciding to leave without your medical team's consent can also be considered unsafe discharge. However, in the case of an AMA, legal liability differs.

There is a lot of gray space when it comes to early discharge malpractice in medical settings. Therefore, it’s always best to communicate concerns clearly and openly with your hospital’s management or discharge planner. 

How can your medical facility prevent unsafe hospital discharges?

First and foremost, you need to ensure that your hospital discharge policies and protocols are up to date. Your professional nursing staff should also be fully aware of and respect these protocols. 

Here are some effective ways to prevent unsafe hospital discharges: 

• Encourage communication amongst the multidisciplinary team about a patient’s medications, follow-up appointments, recovery expectations, etc. 
• Implement training across different teams and departments to ensure that staff members are informed of discharge best practices. From nurses, who create discharge plans, to facility administrators, who focus on ways to reduce readmission rates, it is essential that staff members collaborate, coordinate, and take accountability for safe patient discharges. 
• Make sure you comply with federal laws and state regulations that determine whether or not a patient is stable enough to be discharged.
• Provide your medical team with a patient discharge checklist that includes what determines a patient’s stability, readiness, and requirements to be discharged safely. 
• Offer post-discharge services, making sure follow-up care is in place, such as care transfer support.
• Educate patients about post-discharge protocols and how they should manage their at-home care. 
• Follow up with patients within 42–72 hours to check on and monitor their status.

Other tips to keep in mind for a safe discharge

Although protocols will differ from one facility to another, here are some tips that will help lead to safer hospital discharges: 

1. Check your patient's vital signs: If a patient’s vital signs are not stabilized or worsening, the patient may need to stay for further observation.
2. Give the patient or the patient's caregiver follow-up instructions: Ensure that the patient or their caregiver has access to clear follow-up instructions about managing at-home care.
3. Await full medical clearance: Avoid sending home a patient who has scheduled medical exams. Discharging them prematurely may delay or interrupt a critical diagnosis.

Adhering to these protocols is key to ensuring your patients' safety. This will help reduce your readmission rates, avoid unnecessary fines, and protect your facility's reputation. 

However, sometimes, no matter how eager a facility is to “follow the rules,” factors such as understaffing may still contribute to unsafe discharges and compromised care. 

Ask yourself this: Are my facility’s staffing levels safe?

One of the main reasons hospitals fail to ensure adequate coordination and communication amongst their staff is that there just aren’t enough staff members to cover all shifts. In other words, unsafe staffing levels often lead to communication gaps, delays, and confusion, all of which may lead to unsafe patient discharges. 

What are the advantages of having a fully staffed care team besides safe patient discharges? Happier, more efficient staff members and better patient care (and these are just a few to name). 

Essentially, a well-staffed facility will allow you to better meet the needs of your patients and medical staff. The result? A superpower of operational efficiency. 

Sourcing per diem staff using a marketplace app such as Nursa will allow you to easily fill any schedule gaps. 

Don’t take our word for it; here are real-world examples of healthcare facilities that have successfully used Nursa to quickly fill open shifts and reduce staffing costs, efficiently getting nurses to patients’ bedsides.  

Discharging patients safely

No facility should ever run into a legal case where they are cited for an unsafe discharge. Some of the ways to avoid this are by encouraging staff communication, implementing discharge training, and educating patients or their caregivers on discharge protocols. 

It’s also equally important to make sure your facility is equipped with appropriate staff levels to ensure every patient gets the attention they need. At the end of the day, an unsafe hospital discharge is not worth risking. With the right tools, staff, and strategies, making sure a safe hospital discharge happens every time at your facility is a very achievable goal.

Looking for coverage to ensure safe staffing levels for your hospital? Explore how Nursa can help hospitals connect with local clinicians today to get the help you need. 

Sources:

• Definitive Healthcare: Examining Hospital Discharge Data by State
• Johnson and Biscone: What is an Unsafe or Wrongful Hospital Discharge?
• Centers for Medicare & Medicaid Services: Requirements for Hospital Discharges to Post-Acute Care Providers