Any emergency room visit should be considered high risk. Not necessarily because of the patient's complaint or final discharge but because the ER is a chaotic place by nature. Even if the particular patient's visit and dx is uneventful, the conditions surrounding that patient care might lead to omissions, even errors. For example, a patient who coms for a simple sore throat through fast track is quickly diagnosed, and discharged with prescriptions. But because of the chaos and many other simultaneous patients we miss the fact that the patient is PCN allergic, and that her heart rate was 120's before the patient was discharged. THIS scenario is a real one that happened to one of my patients just a few weeks ago, and the reason I am making this video education regarding the discharge MOS.

The moment of discharge is probably one of the most important parts of the emergency department visit. It gives an opportunity to summarize and educate patient and family regarding the care received, we can answer questions and concerns that the patient might still have, but MOST IMPORTANTLY it helps us 'catch' potential unsafe discharges or misses.
So my goal with this video is to create a clear 'checklist' that any provider discharging a patient should go through in order to increase safety and avoid errors and ULTIMATELY elevate the quality of care that we provide to our patients at Cartersville Medical Center.

Step #1 - the first thing to do when discharging a patient is to ask if the medical provider has had a chance to come and discuss the diagnosis, discharge instructions, and further care.

You see, many times I have every intention of going to the room and doing just this...but I get distracted and you might get to the patient before I have had a chance to do this.
It is essential that the medical provider HAS discussed the tests results, medications, follow up care and discharge plan. Failure to do so is dangerous and a big dissatisfier for our patients.

Step #2 - DOUBLE check the patient identifiers VS the patient discharge instructions.

The current discharge instructions software makes it too easy for the provider to click on a patient with the same last name, even first name...some patients have sons with same last and first name and the only difference is the AGE of the patient, or the second name. MAKE sure that the discharge paperwork that they are getting TRULY belongs to them.

It is also very easy for by mistake have 2 different patient's discharge instructions printed simultaneously making the discharge paperwork mixed with other patient's information.

Giving a patient the incorrect discharge instructions results in disclosing PHI (patient health information) with the person receiving the paperwork and results, though by accident, in a HIPPA violation. Which can result in serious monetary penalties to the provider and the hospital.

I cannot stress enough the importance of this step...
DOUBLE CHECK the patient's ID band against the discharge instructions and make sure that they match.

Step #3 - discuss with the patient the prescriptions written.

Not only to make sure they understand what they are getting, but also to evaluate for a "MISSED" allergy or sensitivity. We all know that when they are told what they are getting, they, all of a sudden, remember that they are allergic to the medication. Most of the time these are not true allergies, but sensitivities. However, they need to be addressed just the same.

Other times these ARE true allergies and we should have definitely caught these before discharge. It is embarrassing to have a call from pharmacy, or worse from an upset patient or parent that we gave the patient a medication that they were clearly allergic to.

And not just allergies, but also interactions. You should be aware of these but if you have doubt you should ask the physician who is caring for the patient. Specifically, there are common and significant interactions with patients on coumadin and antibiotics given...so if we are prescribing and antibiotic and the patient is on commanding these should be explained to the patient as they will need a follow up INR in a few days.

Step #4 - Vital Signs

VITAL...what else can you say about that?
You as the discharging medical provider need to know what are abnormal Vital Signs,
recognize them,
and NEVER ignore them.

NEVER, EVER...assume that the MD/MLP knows about these abnormal vital sign. There are many times that vital signs were not done before the MD/ MLP eval so we have NO knowledge of them.
YOU... need to make sure the MD knows about it, and if they want to discharge the patient with THAT abnormal vital sign then write down the d/c vital signs on the discharge paperwork, then kindly and professionally ask the MD to sign the paper to EVIDENCE that #1 he/she knows about it, and #2 that he/she is OK with the discharge.

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