How to do a Discharge Risk Assessment in the ED
With Dr. Lauren Southerland
For older patients, there are risks of being discharged home, but also risks of being admitted to the hospital. In some cases in the ED the decision to admit or discharge a patient is not cut and dry. In this episode, Dr. Lauren Southerland and I talk about some of the issues and walk through how to do a discharge risk assessment. This podcast is inspired by a recent paper published by Dr. Southerland with colleagues in the US, Australia, and New Zealand that can be found here.
Key Factors in a Discharge Risk Assessment
- It is important to talk with the patient and determine their goals and comfort with admission or discharge are.
- What level of care does the patient need, and do they have access to it? Understand where the patient is going to if they are discharged. If they reside at a facility, what services are available? Is it independent living, an ALF, a SNF? What services or social support do they have if they live independently or with family?
- Know your options! Before the patient is in the ED, discover and find out what your community options are that can utilize paramedic systems, centers of aging, home health, home physical therapy, or other home-based services.
- Consider the following prior to discharge:
- Does the patient have cognitive deficits that could impede his/her recovery and home-based management? Consider doing a quick minicog with orientation questions and 3-item recall to ensure they are able to understand what you have said.
- Is the patient able to ambulate safely?
- Does the patient understand and have access to any new prescriptions?
- Does the patient and/or caregiver understand the discharge instructions and return precautions?
- Does the patient feel ready for discharge or are they worried about it?
- Can the plan and follow-up needs be communicated to the patient’s primary care physician?
References
- Southerland et al. Safe to send home? Discharge risk assessment in the emergency department, Emergency Medicine Australasia 2019 31, 266-270 https://onlinelibrary.wiley.com/doi/abs/10.1111/1742-6723.13250
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This podcast uses sounds from freesound.org by HerbertBoland
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Dr. Christina Shenvi is an associate professor of Emergency Medicine at the University of North Carolina. She is fellowship-trained in Geriatric Emergency Medicine and is the founder of GEMCast. She is the director of the UNC Office of Academic Excellence, president of the Association of Professional Women in Medical Sciences, co-directs the ACEP/CORD Teaching Fellowship, is on the Annals of EM editorial board, is on the Geriatric ED Accreditation board of governors, and she teaches and writes about time management at timeforyourlife.org.