Study identifies gap in care after emergency room discharge

Anyone who’s been on the London tube will remember the constant announcements to “mind the gap.” The idea is to pay attention to the gap between the subway car and the platform when stepping off, so passengers won’t fall and get hurt.

“Mind the gap” is a simple and to-the-point phrase. That’s why it really caught my attention when I recently saw it applied to health care for the first time.

Randy Pilgrim, MD wrote a white paper for SCP Health called “The Gap: Why We Should Care.” He described a perilous gap facing hospital emergency room patients.

The gap is the 5–7 days after discharge from the emergency room, when 50% of re-hospitalizations occur, meaning that patients have to return to the hospital for care.

The white paper provided a list of things you can do to “mind the gap” and make sure your health isn’t compromised after an emergency room visit. We’ve added our comments based on 20+ years of experience in reviewing medical malpractice claims.

• Understand and follow discharge instructions. Discharge instructions can be confusing. A connection of mine on Twitter summed it up well–hospital discharge instructions are about as confusing as a CVS receipt.

Discharge instructions are usually automatically generated by the hospital’s emergency medical record system based on the diagnoses made by the physician, physician assistant, or nurse practitioner responsible for the patient’s care. They are designed to prevent problems in the continuity of care for discharge, but often fall short.

Sometimes the volume of paperwork is just too much and the nursing staff or physician doesn’t do a good job of explaining things. Before being discharged, it’s important for patients to understand exactly what’s being recommended. You can’t follow instructions if you don’t know what they are!

• Fill new prescriptions. If discharge instructions include prescriptions to outside pharmacy, it’s important to make arrangements to have them filled as soon as possible. Some medications are prescribed to be used as needed (PRN), but others should be taken on a set schedule. It’s a good idea to not get behind on medications because that can impact the process of getting well.

• Take medications as instructed, which may be different than normal. Medication reconciliation is an important nursing task that should be completed for every ER encounter. This involves collecting a detailed list of prescription and over-the-counter medications that the patient is currently taking or even recently took. Based on other prescriptions that are being ordered or the patient’s diagnosis, the physician or prescriber may modify the way the patient should take existing medications for a period of time.

• Follow the new plan of care. In many cases that I’ve reviewed it would be a real stretch to say that there was a real plan of care at all. When patients are discharged with the same or worse symptoms than those that brought them to the hospital in the first place, they haven’t really been evaluated and there’s not a true plan of care. In these situations, it’s time to speak up and explain your situation to a physician before agreeing to discharge.

• Schedule a follow-up appointment with a physician’s office. When a patient is discharged from the hospital emergency room, it means that the emergency physician or provider feels that the patient’s condition has been medically stabilized such that it is appropriate and safe for medical care to continue outside the hospital, on an outpatient basis. This is where there’s often a big gap after ER care. ER physicians, nurses, caseworkers, and social workers can help fill the gap by inquiring if the patient has a physician to manage follow-up care. If not, they should provide recommendations.

• Gradually get better. Before getting shown the ER door, it’s critical for patients to know what to expect next. What signs and symptoms should they look for? How long should it take for them to see improvement? Without knowing what to expect, it’s absurd to think that patients will be able to know when to seek medical help.

If you’ve been seriously injured because of poor emergency room care in Texas, then contact a top-rated, experienced Texas medical malpractice lawyer for a free consultation about your potential case.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.