Featured Speaker:

Rebecca Varkett, MSN, APRN, AGCNS,-BC, CMSRN 

Clinical Nurse Specialist for Medical-Surgical and Progressive Care Units at Summa Health System

Scott Webb (Host): The discharge process at Summa Health really begins shortly after a patient is admitted with the goal of a smooth transition to the next phase of care. And joining me today to tell us more is Rebecca Varkett. She's a Clinical Nurse Specialist at Summa Health. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Rebecca, it's so nice to have you here today. We're going to talk about the discharge process, and I was thinking to myself as I was preparing for this, we talk a lot about going to the hospital and checking in and what you need and what time to get there and all of that, but rarely do we talk about the other end of that, leaving the hospital and being discharged. But before we get to that, just tell listeners a little bit about yourself, patient centered care, and we'll just get rolling that way.

Rebecca Varkett, MSN, APRN, AGCNS,-BC, CMSRN: Thank you for having me. Yeah, I am a Clinical Nurse Specialist for med surg and PCU at Summa Health. As a Clinical Nurse Specialist, I'm a nurse who functions to improve outcomes in patient care. This includes being an expert in clinical practice and collaborating with the nurse, the patient, and the system.
Some of the key factors for the patient impact that really include in that patient centered care is you know, we hear patient centered care. It is a growing terminology. You are hearing more and more because evidence is supporting the involvement of the patient and their support person immediately and continuously throughout their inpatient care and beyond to their outpatient care.
The process needs to be tailored to each person's needs, preference, and individual goals. Healthcare is shifting. Our patients and support persons are becoming more involved and more informed due to tools such as MyChart and the Internet. If you read about it, talk about it, bring it forward to your physician, your nurse, or anyone else within your care team. There is good and bad information on the internet, but it will start a valuable conversation between you and your health care team.

Host: Yeah, for sure. And you're so right that, that terminology, patient centered care is becoming part of the nomenclature, I guess, more common anyway, if I can use that word. So let's talk about the patient discharge process. What all goes into releasing a patient from care?

Rebecca Varkett, MSN, APRN, AGCNS,-BC, CMSRN: The discharge process starts immediately. As soon as you arrive to the hospital, staff will coordinate your discharge needs, start reviewing your chart, and meet with your nurse daily. They might work in the background, but they are available if you need them. With some exceptions, the goal is to decrease the length of time in the hospital while returning you to or your loved one, to their residence, which this might be the skilled nursing facility or home. Historically, patients would spend many days in the hospital. Evidence supports, however, that as soon as able, recovery can complete in the home setting. A prolonged stay can actually result in many complications. There are potential extended care options that will be reviewed based on your individual needs, and these may include a skilled nursing facility or you might hear it called a SNF or S-N-F. Acute Rehabilitation Facility, which we sometimes shorten to Rehab. A Long Term Acute Care Hospital, which we call LTAC or you might see as L-T-A-C. Home, of course, and even hospital at home.

Host: Yeah there's a lot of ways or places, you know, where folks can be discharged. Of course, home is home, so you may be discharged home, but that may mean also going to another facility and it's good to have you to sort of sort through this. How about the timing of discharge? What time do hospitals discharge patients? And maybe you could just talk about the process, if you will, that goes into when to release a patient. 

Rebecca Varkett, MSN, APRN, AGCNS,-BC, CMSRN: Many factors influence the time of discharge. The goal is to early in the day as possible. However, there are often barriers to that. Do we need to get you certain supplies? Do we need to get medications in order? Are there conflicting priorities? And also lots of paperwork to go with it.
So communicate with your nurse for a better plan. A physician may come in the morning and tell you that the plan is going to be discharged today, but your nurse will help navigate that timeline a little bit more informed for you.

Host: Yeah. Wondering what the patients can do, you know, we put a lot on the medical professionals, of course, and the whole team there at Summa Health, but is there anything patients can do to kind of streamline the process?

Rebecca Varkett, MSN, APRN, AGCNS,-BC, CMSRN: Yes, be your own advocate. Do not hesitate to communicate concerns with anyone from your care team. The sooner we are aware of your concerns, the sooner we are able to address them. Provide accurate information from the get go, speak up and ask questions. Start planning for your discharge as soon as you walk in the door.
Think about the barriers you may have. For example, I'm walking with a walker here at the hospital. Will I need one at home? Or perhaps you've had trouble getting around prior to arrival and there could be something we can help you with. Work with your physical therapy and occupational therapy as soon as possible.
This is a team that works with you to determine your needs for discharge. This could include equipment from home, for home, that you would need or could be rehab or a skilled nursing facility. That would be a stepping stone for you to go home. The case manager or social worker will start to plan as soon as possible so that we are prepared when you are ready to go.
Most insurances require a prior authorization which can result in significant delays. A delay in working with physical therapy and occupational therapy early could result in longer stay in the hospital when you are really ready for that next step in your recovery. And importantly, reference your discharge paperwork and MyChart. It will provide information, such as contact information if any questions or concerns arise once you are home.

Host: Yeah, that's perfect. And such good advice for folks to just really advocate for themselves, think ahead, plan ahead, advocate for themselves, and maybe just be a little patient. No pun intended. And also, a little flexible. Want to ask about surveys. It seems like we can't go anywhere, Rebecca, restaurant, store, everywhere we go, we end up getting a survey afterwards.
And I'm just not sure that folks really read them, but I really believe that hospital systems do. And I know that you do there at Summa. So maybe talk about that if patients are going to receive surveys and to what end, why is it important for them or why do you want them to complete them.

Rebecca Varkett, MSN, APRN, AGCNS,-BC, CMSRN: I agree, we are sometimes bombarded with emails and mails and asking for surveys, and Summa will send you a request either by mail or email or phone call and it is very valuable to complete when you have suggestions for improvement and also when you feel something went really well. If you had a good experience, we want to make sure others do too.
So these surveys really do help us make changes to improve your experience and anyone else that comes to the hospital thereafter. Also, if you know writing a google review or any other review suggestions that you have you might get a notification from that. We appreciate your feedback and rating for that because it helps other patients find services that they might need, and decide which provider they would like to use.

Host: Yeah, for sure. Patients, just as we talk about restaurants or whatever stores, patients have options, right? They don't have to go to Summa Health. We'd like them to go to Summa Health, but they don't have to go to Summa Health. So all of these reviews, they all add up. They all matter. This has been really good today as we prefaced there. We don't often talk about the other end, the discharge side of the hospital experience. I'm glad we did that today. Just give you a chance here, final thoughts and takeaways.

Rebecca Varkett, MSN, APRN, AGCNS,-BC, CMSRN: Yeah, I just want to encourage folks to visit sumahealth.org for more information. Click on the patient and visitor tab, it's at the top, or MyChart it gives tips and tricks on how to utilize MyChart and set it up. That is absolutely helpful. And again, always reference your discharge paperwork and please ask questions.

Host: Yeah, that's a perfect way to end. You should, we should get some t-shirts made there around Summa. Just please ask questions, right? Rebecca, this has been great. Lots of great information. Great spend some time with you. So thanks so much.

Rebecca Varkett, MSN, APRN, AGCNS,-BC, CMSRN: Thank you so much for having me. 

Host: And for more information, go to summahealth.org/cci. And if you enjoyed this episode of Healthy Vitals, we'd love it if you'd leave us a review. Your review helps others find our educational content. I'm Scott Webb. Thanks for listening, and we'll talk again next time.