So, you are ready for discharge. Glad to be going home. Everything has gone well with no sign of complication. What happens next?The surgeon, nurses, physician assistants, discharge planners, and social workers are always thinking about the transition from inpatient to outpatient. The process of discharging a patient begins the day of the operation. Everyone wants this process to be smooth and result in the best outcome for the patient.
The first step is a communication between the surgeon and patient. You are going home today? Next, the surgeon will prepare discharge materials. Nursing will provide discharge education, such as drain care or dressing change instructions. Necessary supplies and prescriptions are filled.
Just before discharge, all IVs are removed and the nurse provides discharge materials.
You should receive the following:
1) Summary of hospital course
2) Updated list of medications
3) New prescriptions
4) Follow-up plan with appointments
5) Nursing or care instructions
6) Contact information
7) Record of operation
8) Record of pathology
9) Activity restrictions
10) Instructions on when to call the surgeon.
Double check that you receive all these materials. I'll explain why they are important.
Summary of Hospital Course: Hopefully your post-operative recovery was uncomplicated. Even if your stay in the hospital was boring, the events of the hospital stay should be documented. This documentation can be given to your primary care doctor or other providers. It is very insightful. Keep this summary in your records.
List of medications: Medications frequently start and stop after major surgery. You need to know what you should and should not be taking. Stop and ask. Get clarification from the nurse. Do new medications have side effects? Can you stop taking any medications? Are there redundant/duplicate medications? Do you need a refill on a medication? Keep this list and take it your primary care doctor so that everyone has an up-to-date medication list.
New prescriptions: When you are discharged on the weekend, filling new prescriptions can sometimes be difficult. Can or should they be filled before discharge? When should you take the next dose? How long will you be taking the new medication(s)? All of these questions can be answered by the discharging nurse.
Follow-up plan: Ideally, the follow-up plan is established before discharge. Sometimes, because of office hours, appointment times can't be arranged. If the plan is not clearly outlined in the discharge paperwork or conflicts with your understanding of the follow-up plan, ask for clarification. Every operation and every patient is unique and follow-up plans require customization. Before agreeing to specific appointment times, make sure you factor in transportation and if your driver needs to take time off work.
Nursing or care instructions: This documentation depends on the operation. Just ask the nurse, "Do you have any post-operative care instructions for this operation?" Make sure supplies are provided if you need to flush drains or change dressings.
Contact information: Make sure you receive a physician on-call number, surgeon's office number, medical records contact number (if you need to have records forwarded), and main hospital number.
Record of operation: This is not routinely included in the discharge materials. However, request the operative note for your records. Since the final version of the operation note does take several days before it is available, you might have to request the operation note as an outpatient.
Record of pathology: Similar to operation notes, pathology reports are not always included in the discharge materials. The detailed pathology report can be very technical and difficult to understand but is a very important document especially for patients with cancer. This document describes the size, stage, and lymph node status of a tumor. Pathology reports are not typically available until 3 - 5 days after an operation so you might have to request a copy as an outpatient.
Activity restrictions: The discharge paperwork should outline activity restrictions. This includes comments on lifting, sexual activity, driving, bathing, and swimming.
Instructions on when to call the surgeon: Typically, the discharge paperwork will state that you should call your surgeon when you have fever, chills, nausea, vomiting, or redness at the incision. Beyond these common instructions, make sure to ask your surgeon or nurse what to look out for after surgery.
So, you have your discharge paperwork in hand. IV is removed. Are you ready to go? Yes and no. Ask the nurse before you walk out the door since many hospitals provide or require that you take a wheel chair to the lobby.
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