The Discharge Call Nobody Prepares You For

For twelve years my job was the four hours after the decision.

A hospital decides that someone is going home. That decision is medical, and it is usually correct. What follows it is not medical at all: it is logistics, and the logistics land on a family, usually with a few hours’ notice, usually by telephone, and usually on whichever family member happens to answer.

That person becomes the plan. Not the best-placed person, not the person with the spare room, not the one who lives eleven minutes away. The one who picked up.

What the call actually contains

The call will tell you a discharge is happening, often today. It may tell you a time. It will contain a great deal of accurate clinical information delivered at a speed that assumes you have a pen.

It will not tell you the things a household needs, because the person calling does not know them: whether there is food in the house, whether the stairs are a problem now in a way they were not three weeks ago, whether anyone will be there overnight, whether the medication that has changed is one your father has been taking wrong for a year.

I have made several hundred of these calls. The families who did well were not the ones with money or with medical knowledge. They were the ones who had already decided who takes the call.

The three things to have before you need them

The full set is in the six documents to find before you need them. The three that matter in the first hour:

A current medication list, on paper, in a pocket. Not a photograph of a pill organiser. The list changes at every admission and the reconciliation at discharge is the single most error-prone document in the process. Ask for the reconciled list before you leave the building.

The discharge planner’s name and direct line. Every hospital has this role and it is called something different in each one — case manager, care coordinator, transition nurse. Ask on day one, write it down, and use it. This person can move an assessment forward by a day. The main switchboard cannot.

A written answer to: who is in the house on night one. One sentence. A name and a phone number. Families who cannot answer this on the phone are the families for whom the discharge quietly becomes a readmission a fortnight later.

The question nobody asks

You can say the house is not ready.

Not as an objection, and not as a bid to keep somebody in a hospital bed they do not need. But if there is nobody in that house until Thursday, the discharge planner needs to know that, and in my experience families withhold it out of a sense that they are supposed to cope. They say “we’ll manage,” and then at 9 p.m. an 81-year-old is alone with a walker and a new prescription and a set of stairs.

Say the true sentence instead. “There is nobody there until Thursday.” It is information. It is not a complaint, and the people receiving it deal with this every day.

What this piece is not

It is not medical advice, and there is nothing in it about treatment, because that is not my expertise and this magazine does not publish clinical claims that a clinician has not checked. What I know is the paperwork and the four hours — the part of illness that is administration, that lands on a household, and that nobody is ever trained for.

The households that handle it are not the ones who know more medicine. They are the ones who decided, before the phone rang, who picks up.