Medical Readiness for Discharge
An inpatient is considered "medically ready" for discharge when the primary provider discipline (referred to as "medical" for simplicity) for an inpatient encounter has completed its clinical tasks and the patient is dischargeable from a "medical" perspective. Other needs (e.g., further mobility promotion, destination facility readiness, community home care readiness) may require more time to be spent in the current hospital. Accordingly, the expected discharge date may differ from the medical readiness date.
There is no precise definition for Medical Readiness ("Ready"), since facility, service, ward and patient factors determine Readiness for specific patients cared for in specific contexts. A tertiary care hospital organ transplantation service, for example, may declare a patient Ready for transition to a different level of care (and, possibly, facility) at a higher level of patient complexity and acuity than a community hospitalist service managing a common presentation.
Typically, a patient's level of care is changed from "Acute" to "Alternate Level of Care" once the patient is medically ready for discharge (see Alternate Level of Care).
Connect Care provides discharge planning tools that track Medical Readiness for Discharge (MRD) as well as Overall Readiness for Discharge (ORD). Planning for straightforward discharge needs can be facilitated with the simple MRD determination. Planning for more complex needs is best done with the multidisciplinary ORD tool. The ORD includes the MRD, as well as Allied Health Readiness for Discharge (as reflected by attainment of Allied Health discharge planning milestones) and Mobility Readiness (as reflected by attainment of safe handling mobility discharge target).
Medical Readiness for Discharge (MRD)
Connect Care discharge planning tools (as found in patient list sidebar, chart sidebar, patient list columns, etc.) include a binary button ("Ready Now", "Not Yet Ready") that is used to indicate whether a patient is medically ready for discharge. The date of determination is automatically recorded. Immediately below this button is a "mark as reviewed" button which can be used to re-validate the MRD, or to indicate that the currently displayed value is as intended.
The focus is on "medical readiness" for discharge. There is no precise definition, as the conditions for medical readiness will vary by type of facility and hospital service. In general, a patient is medically ready when the primary hospital service has completed all tasks needed to manage the reason for admission. From a medical perspective, the patient would be dischargeable from that hospital service, even though other disciplines may need to complete work to enable a safe discharge.
Nursing and allied health readiness is tracked through discharge milestone indicators reflected in the ORD.
Overall Readiness for Discharge (ORD)
A multidisciplinary discharge readiness planning tool can be accessed from within the Rapid Rounds List (double-click on the Overall Readiness for Discharge column or "traffic light" icon), Rapid Rounds Report (click on the "discharge readiness" section text) or inpatient chart transition plan (again, click on the "discharge readiness" section text).
The sidebar or pop-up ORD tool facilitates simultaneous management of medical readiness, nursing and allied health readiness and attainment of the mobility target needed for discharge. It also provides indicators of mismatches between medical readiness and level of care, with quick-links for bringing these attributes into alignment.