Managing access and flow through appropriate discharge: preventing common errors and improving processes.
Increased pressure on acute care hospitals to move patients seamlessly through the healthcare system has resulted in more attention to the process of discharging patients, particularly seniors, from hospitals. When alignment with the Health Care Consent Act is lacking, errors can occur in the process. Examples of mistakes by healthcare professionals include these: taking direction from the wrong substitute decision-maker (SDM); taking direction from a family member when the patient is capable; allowing an SDM to make an advance directive on behalf of a patient; being aware of a known prior expressed wish but ignoring that wish when considering a placement plan; waiting for an SDM who is not available, willing and capable instead of proceeding down the hierarchy of decision-makers; or permitting families to propose discharge plans. Such errors have the potential to compromise quality of care, but they also work to prevent timely and appropriate discharge. In order to minimize these common errors in the consent process for placements, we have proposed a checklist to help meet ethical and legal obligations in the discharge process. We suggest the checklist may minimize avoidable conflict and misunderstanding and promote a seamless discharge process.
Member of the William Osler Health System, in Brampton, Ontario. You can contact her by email at Paula.chidwick@williamoslerhs.ca.
Paula
P
Chidwick
Member of the Department of Family Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, and the London Health Sciences Centre, in London, Ontario.
Robert W
RW
Sibbald
Member of the William Osler Health System.
Terri-Lynn
TL
Hansen
Member of the William Osler Health System.
Christopher
C
Parkes
D000368:Aged; D000369:Aged, 80 and over; D057189:Checklist; D003266:Continuity of Patient Care / Q000592:standards; D006297:Health Services Accessibility / Q000592:standards; D006761:Hospitals / Q000592:standards; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control*; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology; D010351:Patient Discharge / Q000592:standards; D011787:Quality of Health Care / Q000592:standards; D020458:Third-Party Consent