Critical Path Network-Psychiatric hospital updates its discharge planning path
By Cynthia Leslie Shippy, RN-C, CCDC, MSN
Good Samaritan Hospital
Downers Grove, IL
Good Samaritan Hospital in Downers Grove, IL, has developed diagnosis-driven critical pathways for inpatient and outpatient psychiatric services. These paths were developed to assist discharge planning to ensure that patients followed a continuum of care that met their needs. (See Hospital Case Management, July 1999, p. 123.)
Discharge planning is one of the most important aspects of health care today. Managed care companies incorporate this question during the first utilization, then expect finalized outpatient plans before discharge. The multidisciplinary team — composed of case managers, social workers, clinical nurse specialist, unit nurse manager, and case coordinator — discusses discharge planning with the patient and the doctor on a daily basis.
Discharge groups help twice weekly
During the first 24-hour staffing the initial discharge plans are reviewed and then at subsequent staffing, discharge plans are reviewed and finalized.
The "Discharge Planning Workbook," developed by a committee, incorporates the discharge planning process. Patients and staff continue to discuss the discharge process daily in small groups. The social worker holds weekly discharge group meetings. Families are involved when appropriate. Our discharge planning continuous quality improvement committee suggested to the manager that the following suggestions be implemented:
1. The discharge group should meet twice a week rather than once a week because the length of stay has changed from 10 days to six days on the adult crisis stabilization unit since 1994.
2. Inservices on documentation need to be given on a regular basis (monthly) by the utilization review nurses to educate staff as to the questions managed care companies are asking on a daily basis. Axis and global assessment functioning issues need to be identified at the time of the initial review and again at the time of discharge. The same questions are repeated at discharge and additionally, the final discharge plans are reviewed and the date and time of first appointment with the doctor after discharge is discussed. Even if the patient is being seen at the local county mental health clinic at the time of discharge, an appointment has been scheduled to see the psychiatrist.
3. All registered nurses will continue to make daily callbacks to patients the day after discharge. During the call, the patients' present status are assessed and they are asked if they are continuing to take the medication prescribed and still have an appointment to see the psychiatrist. The nurse will reinforce the importance of the medication and follow up with the psychiatrist.
The quality improvement committee made a commitment to meet monthly and re-evaluate the "Discharge Planning Workbook" and feedback received from patients, families, and staff.
Discharge planning is one of the most important aspects during the hospital stay. Our aim for the inpatient crisis stabilization unit is to discharge patients after having met the goals that they need to continue to function at their most optimal level. Resources need to be in place so hospitalization is the last resort.
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