Discharge planning
Formal Definition
The process of preparing a patient to safely transition from an inpatient or emergency setting to their home or next care setting; includes medication reconciliation, arranging follow-up appointments, ensuring durable medical equipment, verifying home services, patient education, and confirming the patient and family understand the plan and warning signs that should prompt return to hospital.
How It's Used on the Ward
Discharge planning or getting the patient ready to go home — all the non-clinical work that has to happen to make sure a patient does not end up back in the hospital 3 days later.
Example
"Discharge planning for CHF patient: medications reconciled (furosemide increased, digoxin held, new Entresto started), follow-up cardiology appointment scheduled in 7 days, daily weights instructions given, scale provided, home health nurse arranged for daily vitals check, wife educated on "if you gain 3 pounds in a day, call us." Discharge summary notes pending results section and follow-up plan."
Clinical Context
Medication reconciliation: most common source of post-discharge adverse events. Compare home meds vs inpatient meds vs discharge meds. Follow-up: who is the primary care provider (PCP)? Can the patient afford medications? (340B, pharmacy assistance programs). Red flag education: come back if... — specific symptoms to watch for. Readmission as quality measure: CMS penalizes hospitals for 30-day readmission rates for CHF, MI, pneumonia. Post-discharge phone call within 48h is standard practice and reduces readmission. Social determinants: transportation, food security, housing stability — connect patients to social work for assistance.