Years ago, when patients had extensive hospital stays, a discharge manager simply met with patients to be sure they knew how to take their medications and had a follow-up appointment with their doctor. Patients are now being discharged after only a minimal hospital stay making the job description of a discharge nurse manager more detailed than it once was.
Since patients are going home earlier, they need more follow-up services and attention paid to their home care. As a result, the duties of a discharge manager have become more complex and comprehensive in order to optimize the chances for a positive outcome after any medical or surgical hospitalization. A discharge manager needs certain skills associated with each duty.
1) The ability to assimilate relevant information is a necessary skill since discharge planning begins with admission screening.
A discharge nurse manager needs to be able to analyze and assimilate relevant information in order to obtain the facts necessary for proper screening of the patient at admission. The screening needs to be done with a view towards services that may be needed at discharge. This includes a review of basic information such as:
• The age of the patient.
• Living status and conditions of the patients such as, do they live alone, do they live in a nursing home, do they live with relatives or are they homeless. Are they under the care of hospice?
• Reason for the hospital admission. Is it for a simple surgical procedure, a medical emergency or crisis, or is the patient a victim of a crime.
• Any other relevant information.
2) Comprehensive assessment skills are needed in order to identify problems.
The discharge manager must be skilled at assessment since a comprehensive assessment is required that builds on the admission screening. This involves a patient interview and review of the past medical records as well as the ones applicable to the current hospital admission.
The assessment includes evaluation of the patients’ housing needs and whether any accommodations will need to be employed. For example, someone who has now been relegated to the use of a wheelchair, but has a bedroom at the top of a flight of stairs, will need more services than someone who had an appendectomy and plans on taking a few days off of work.
3) Diplomacy skills are needed in order to co-ordinate with all involved health care providers.
Many health care providers will be involved in discharge planning including, for example, the dietician, pharmacist, physical therapist and physician. The discharge manager needs to be able to work with all those involved in order to put together a comprehensive plan that meets all the patient’s anticipated needs.
4) The discharge manager needs to be aware of available resources in order to develop an appropriate plan.
Problems that have been identified need to be met with resources to solve them. The discharge nurse manager needs to be aware of what those resources are and how they are accessed. For example, a newly diagnosed diabetic patient may need general education about diabetes as well as meeting with a dietician. A newly bedridden patient may need help in accessing a medical supply company for a hospital bed at home as well as coordination with their insurance provider for payment. The discharge manager needs to know where these resources exist and how the patient can access them.
5) The discharge manager needs good communication skills when meeting with the patient to implement the plan.
Implementing the discharge plan does not mean “telling” the patient what the plan is, but genuine communication with the patient based on their needs and resources that have been found to meet those needs. For example, the diabetic patient may be resistant to the need for diabetic education. The discharge manager needs to use effective communication skills so the patients will be receptive to utilization of the resource and not feel it is something imposed upon them.