DISCHARGE is a ‘painful’ process for patients, doctors and nurses

Patient:
Long hours of waiting. Morning specialist informed allow discharge, but still need to wait until 3 – 4 / 5 pm. In fact many patients would want to go back home stat once allow discharged.
“Why I still cannot go back yet? Waiting for so long already / My wife is otw already”
“Is my medicine ready?”

Doctors / HO

• Discharge note
• Discharge summary
• Casemix
• Discharge medication (cannot miss out patient’s medications even one)
• Memos to KK, other departments, miscellaneous memo etc.
• Radiological appointment for certain cases (need to fill in the form, meet ROTD to request)
• Lab investigation outpatient for certain patient: to prepare lab forms
• Need to call back MO referral from other departments to get discharge plan from their side

But….
There might be more than one discharge under your care

There might be many other pending active plans for other patients who are still not yet discharge (blood taking, referral, entry for whatever thing, trace result, etc.)

Nurses:
Need to settle billing details for the patients

Need to explain to patients regarding discharge plan – next appointment, which memo / referral letter etc.

Need to dispatch interdepartmental / intradepartmental case notes as soon as possible during office hours to get appointment date.

Example of AM shift 7 am – 7 pm

5.30 am – 6 am arrival to hospital & start reviewing patients (AM review)

• 6 to 10 patients
• trace am blood & previous results e.g. CRP, blood C&S
• subjective & objective review, and plans

7.45 am – 8.45 am round with MO

• present to MO & review together with MO

8.45 am – 10 am / 10.30 am round with specialist
*My specialist will be more careful and see each patient thoroughly, check patient’s vitals, I/O, dxt, BO, medications chart etc.

• MO presents to specialist if MO knows the case, otherwise HO will present

By the time around 10.30 round finished / round continued with consultant round – can be short / taking longer time // can continue specialist’s plan or can change specialist’s plan tremendously

Pending plan after all round:

1. Stat blood for certain patients (stat = take blood as soon as possible, and update MO / specialist the results by afternoon)

2. Imaging request, i.e. need to go to present to ROTD (need to know case well, the justification of urgency, and the indication)

3. Discharge

• memo to KK, memo to other departments, memo to other hospital, memo to other units of the same department (usually can type and print out)
• call MOs from respective departments to give discharge plan from their respective departments
• Casemix form
• Discharge note
• Discharge summary
• Outpatient medications (needs to be countersigned by MO; certain medications require JKTU form signed by specialist)
  ***Sometimes nurse in charge will rush you to settle the discharge stat, because they need to discharge pafient from the system, and key in for billing purpose, while there are many pending cases from ED

4. 2 pm / 2.30 pm onwards: PM review, especially for dengue patients or acute cubicle

5. 4.30 pm onwards – approaching end of office hour: Radiology, clinic and certain pathology counters are closing. Any special appointment / radiology or lab request will be unavailable after office hours

6. Prepare coming morning blood forms

7. 7 pm – go back on time, if managed to settle and handover everything on time

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Other events between 7 am – 7 pm:

1. Attending any medical emergency e.g. chest pain, SOB, hyperglycaemia, hypoglycaemia

2. Set branula (including spending more than 30 minutes dealing with difficult line)

• “doktor, branula tercabut”, “doktor, branula leaking”, “doktor, branula tak jalan”, “doktor, branula required” etc.

3. Clerk new transfer-in or new case from ED

4. Referrals & carry out plan given by MO that you referred

5. Nurse handover — you should not touch patients’ case notes / medication charts / observation charts during nurse passover, or else it would disturb their handover session

6. Having lunch / short break if there is enough time

Can you do these? Let’s try to work smartly and go back home on time together