Tweaking the discharge process

During my inpatient months I had not thought much about where the patients end up after their stay.  I know many are going to SNFs and rehabs, but I mostly just imagined a hospital-like setting with a focus on rehab and PT instead of on medical issues.  However, during my first week of geriatrics I realized how vastly wrong my ideas had been.  The care of patients in SNFs seems to be a cross between a hospitalist and a PCP.  You get to see the patients several times, in their normal clothes I might add, over the course of several weeks and are able to build a relationship with them and see (most) improve and able to return home.  You also realize all the things that fall through the cracks on discharge.  The person has diarrhea? It's good to know they don't have C.diff, but it might also be helpful stopping that BID sennakot-s.  Oh, yea lets remove that rectal tube at some point as well.  They were taking Benalopril prior to admit, lets change them to lisinopril b/c it's formulary on discharge.  They are confused, but we don't know what the baseline is, so we cannot justify hospitalization, so lets get them someplace where someone can keep watching them instead of dc'ing home, it's in the best interest of the patient after all.  All of these issues, and so many more, seem kind of oxy-moron after discharge, but while you are getting paged every 5 minutes you lose focus on the fine-tuning.  Being responsible for the discharged patient made me so much more aware of my discharging process, and I wish I had had that experience from the beginning of my residency. 

 -- Kellie Wark