The goals of a discharge program should be to reduce errors in the discharge process, educate the patient to understand the treatment plan and set expectations for follow-up with providers, upon returning home. Traditional hospital discharge programs may fail patients due to drawbacks with the program design and challenges with program implementation.
Drawbacks of the program design typically arise if the program is not patient-centric. The patient may be provided with verbal instructions and quickly forget them soon after discharge. Written instructions may be provided to the patient but the patient may forget to share the information with a caregiver. A patient’s level of English proficiency, health literacy, and socio-economic status can also play a role in his/her ability to understand the discharge program. And, a discharge program might not account for ethnicity and/or gender differences amongst patients; patients from different cultures may not express concerns, questions, or needs due to social mores.
Challenges with the program implementation may result from the program’s focus on the hospital discharge vs. the transition in care. Some examples of this:
- Discharge may be a low level priority for providers and relegated to the least-experienced team member.
- Last-minute tests/consultations can delay the discharge plan. Patients (and their caregivers) may feel rushed thru a “checkout” process vs. being adequately prepared for how they are to perform self-care post-discharge.
- There is not always clear ownership of the transition and next steps might all fall on the patient, even if they are not ready, such as scheduling follow-up appointments, securing transportation to/from the pharmacy and appointments, etc.
- The discharge program might not directly involve the patient’s caregiver who could share the responsibility for adhering to the transition plan.
- A patient may return home, become complacent after the initial few days of recovery, and fail to complete the entire dosage of prescribed medicine.
- Communication of the program might fall short if it is only limited to the hospital team members but not shared with subsequent care facility team members.
With a virtual care platform, case managers and care coordinators can conduct virtual visits with discharged patients – and include one’s personal caregiver, a pharmacist, a specialist, and other care team members – in order to discuss progress and adherence in real-time. Virtual visits can help keep patients:
- Informed: Medical staff and pharmacists can inform a patient of the rationale for the new treatment plan medication and also convey the routine prescribed for adherence.
- Engaged: Patients can participate in the virtual visits with medical staff and pharmacists at their convenience – from any device, at any time, and from anywhere – which allows the patients to have a conversation in a more familiar and comfortable setting (such as their home) vs. the traditional four walls of a physician’s office or the local pharmacy.
- On Track: Virtual visits provide medical staff with the opportunity to educate the patient about one’s condition, why one’s medication has changed, , and what side effects may occur.