Deciding on the proper time to discharge a patient can be a difficult decision and is impacted by a variety of factors. Poor decisions about discharging a patient can result in risk to the patient's health and later readmission for a recurrence or development of a secondary condition. Defining the obstacles to effective discharge practices can help providers to improve processes resulting in better patient care and fewer incidences of patient readmissions.
One factor that negatively impacts effective patient discharging can be the system itself. Issues such as having too few beds impacts the ability to make decisions by placing necessary constraints on the length of stay of some patients. In order to admit other unhealthy new patients, decisions must be made on who must be discharged, which can result in release of a patient who may actually benefit from receiving further care in the inpatient setting.
Another system issue is lack of staff. If physicians are overworked, they are unable to communicate appropriately with nurses and other staff resulting in a disconnect in communication from physicians to patients. Patients may, then, be undereducated regarding their care plan, negatively impacting their ability to successfully and fully recover.
Some healthcare practitioners have cited patient preference as a barrier to effective discharge. Most cited was the hesitance of older patients to leave the hospital, particularly when lacking a caregiver at home. In many situations, older patients without caregivers are resistant to going to assisted living facilities and therefore oppose discharge.
Additionally, some healthcare professionals state that some patients lack of ability to understand how to take their medications or follow through on other post-discharge instructions, despite repeatedly providing the information, is a problem that contributes to readmission.
Social factors can be highly important in determining the success of a patient's recovery. Discharge planners must learn about the patients' social construct in order to effectively plan discharge and post-hospital follow up care. Issues such as transportation, lack of family support, inadequate funding, and time lag between discharge and receiving financial assistance from social programs can result in a patient not recovering as he otherwise would.
Sometimes healthcare professionals themselves can stand in the way of effective discharge planning. Nurses want to be more involved in the physician's care of a patient and the decision making process, and cite that often physicians will rotate off duty or to other hospitals leaving and become unavailable to contact making it difficult to determine the physician's preferred post-discharge plan.
Other healthcare staff point out that many healthcare professionals are not investing the necessary time to determine the patient's situation outside of the hospital in order to be able formulate a realistic plan of action for after the patient is released.
In some situations, resources outside of the hospital are difficult to access due to various factors including education about resources, transportation to resources, geographical proximity, and various other factors. Often, finances can limit the ability of hospitals to provide extensive post-discharge follow up, resulting in an unsuccessful recovery and often readmission.