Inadequate Discharge Planning from ED – An Overlooked Cause of Hospital Readmissions

We all understand the importance of an effective discharge plan for safe post-discharge care and to prevent avoidable readmissions. However, several research studies indicate that the discharge planning process is not conducted as effectively for patients discharged from the emergency department as compared to inpatients. As a result, we see an influx of readmissions into the ED which could have been avoided if the discharge plan was prepared keeping in view the individual patient’s needs and risk of developing post discharge complications.

Emergency services is a busy area with staff handling multiple complex patients at the same time. This leaves little room for detailed history taking, examination or medication reconciliation. Due to pressure of limited bedspace, increased patient turn over and staff work load, patients are discharged as soon as the emergency is relieved and their condition is stabilized. There are chances of premature release, overlooked critical diagnostics or inadequate discharge instructions leading to unforeseen adverse outcomes resulting in readmission to the ED, shortly after initial discharge.

Suggested recommendations include identifying medium-to-high risk conditions that could serve as a guide to indicate which of the admitted patients would be needing a more detailed discharge plan. These are usually the patients with complex care needs due to multiple conditions or comorbidities putting them at risk of developing secondary complications.

The hospital’s quality dept. can step in to help develop KPIs and gather data on past readmissions in ED. This would give objective analysis of the top most conditions that could be identified as medium to high risk upon admission so as to develop countermeasures and well-informed discharge plans to reduce preventable readmissions.

Patients and their care takers must be educated and alerted about the possibilities of developing post discharge complications and how to take appropriate and timely measures. Wherever possible, there should be a proper system to follow up with high-risk patients within 24-48 hours after discharge.

Discharge plan must include verbal and written post discharge instructions including details about the diagnosis, tests and procedures performed, treatment given, home care, medications, follow-up instructions and reasons to return to the ED. Nearly all patients discharged from the ED should also be given directions to arrange a follow-up appointment as soon as possible, with a primary care provider.

We must keep in mind that discharge from ED is a high-risk check point in the transition of care and therefore a comprehensive discharge plan plays a pivotal role in ensuring safe care, timely availability of resources to meet post discharge needs and mitigation of preventable readmissions to ED and hospitals.