The moment a patient is discharged from the emergency department (ED) should be a moment marked with confidence for both the patient and ED staff. Each party should be satisfied with the care provided and that the chance of a return visit to the ED in the near future are low.

A visit to the ED is typically stressful for a patient and their families. From the time they walk in your door until they get to discharge can be an arduous experience. But by engaging patients with effective communication throughout thier experience and especially before the leave they’ll be empowered with the necessary knowledge to ultimately take control of their care.

One important tool for effective communication every ED should utilize is the discharge checklist.

According to the Robert Wood Johnson Foundation, patients should have a solid understanding of these six things prior to discharge:

Their overall care plan;
Where they will be going after discharge;
If transferred, who to contact if a problem arises;
Medication instructions along with potential side effects;
What symptoms to be on the lookout for;
And any necessary follow-up appointments.

This is a lot of information for a person or family to absorb, especially when they find themselves in the ED. A strong discharge checklist will provide this essential information in a way that’s easy for patients and caregivers to understand as the ED staff person reviews it with them and once they take it home. Just as important, a strong discharge checklist will instill confidence among the ED staff that all pertinent information has been shared with the patient.

So, what does a strong discharge checklist look like?

The best discharge checklists are educational in nature and address social and medical risk factors that could result in a return visit to the ED. If the patient is homeless, a list of area agencies that offer housing assistance should be included. The same goes for patients who have issues involving substance abuse.

Strong discharge checklists should also be simple in form and created with the demographics of the community the ED serves in mind. If there is a high population of Spanish-language speakers in the community, it’s best to have the checklist available in Spanish as well.

Discharge checklists of course can’t be tailored to every individual patient, but a strong checklist will cover the necessary bases to ensure discharge is successful for the vast majority of patients.

The Robert Wood Johnson Foundation offers a good model for what a strong discharge checklist should look like, as does Medicare.gov. The important element these two checklists share is that they both empower patients and caregivers with points of action.

For example:

I understand what symptoms I need to watch out for and whom to call should I notice them.

This is a good example of how proper wording places the primary responsibility of care on the patient with ED staff acting as a guide. Nurses aren’t checking off the box when they relay necessary information to patients. Instead, patients and caregivers are checking the box off when they have a firm grasp on the information that’s been presented to them.

The discharge process for every ED is different, but the one tool each should be utilizing is a strong discharge checklist. While there’s not a “one-size-fits-all” checklist out there, Donovan and Partners is available to assess your ED and help you develop a tailored discharge checklist to lower return rates and improve the discharge process. Contact us today at cmd@constancedonovan.com or 651-260-9918.

SOURCES:
Robert Wood Johnson Foundation: “Care About Your Care Discharge Checklist & Care Transition Plan.”

Medicare.gov: "Your Discharge Planning Checklist."

American College of Emergency Physicians: “Improving the ED Discharge Process.”