When people have recovered sufficiently or can be appropriately treated elsewhere, they are discharged from the hospital. Staff members may ask questions to determine whether people are likely to need extra help after discharge. A discharge planner or a social worker at the hospital can anticipate which problems are likely, then make suggestions about and arrange for needed services. However, people and their family members should be involved in the plans to make sure they are appropriate.
If further care is needed temporarily or permanently after a hospital stay, people are often sent to another facility. They may go to a rehabilitation facility or a nursing home (skilled nursing facility). Sometimes care can be continued at home (see Provision of Care: Home Health Care).
Before leaving the hospital, people or their family members should make sure that that they receive detailed instructions for follow-up care and that they understand the instructions. They should get a written schedule for using all their drugs and for follow-up appointments. If people are being discharged to another facility, a written summary of their hospital evaluation and treatment plan (called a transition care record) should be sent with them and another copy faxed to the facility. Information in this record should include the following:
Last full review/revision February 2009 by Robert M. Palmer, MD, MPH