Before patients can be discharged from a hospital, they must be taught
how to take care of themselves at home. They might need special equipment
such as oxygen and ventilators. Or they might need ongoing care from a home
care nurse. Discharge coordinators make sure these arrangements are in place.
Robin Bisgaard used to be a discharge coordinator. "I always liked working
with the families who had gone through so much. I liked teaching them what
they needed to know to take their child home," she says. "I had done pediatric
home care on the side, and I thought I was good at making reality-based decisions
about life at home."
A typical day for Bisgaard started by collecting information on new patients
that had arrived during the night. Then she entered the information in the
database and initiated the insurance process. She had to make sure that the
insurance was OK. Then she collected demographic information from the child's
parents.
"It wasn't just coming in on the day of discharge. I did utilization reviews,
looked after home care issues and other things that would come up with the
babies," she says.
Bisgaard's day included teaching families, or making community appointments
for kids who would be leaving soon. Each patient required anywhere from 15
minutes to three hours of education on discharge day. Some days there were
as many as five discharges -- those were very busy days.
Bisgaard worked case by case, writing the orders that the doctors would
later sign. "I made sure the family education was all done, or made sure that
the bedside nurses understood what was to be taught."
In the afternoons, after the discharges were finished, Bisgaard attended
appointments with parents or committee meetings.
The job can be frustrating. For example, sometimes a child needs to take
a ventilator home, but there is no home care company with an available ventilator.
At other times, it is impossible to find a physician to care for a high-risk
baby because of insurance issues.
Since Bisgaard works at a big teaching institution, she often works with
transient resident physicians. "Sometimes they discharge a patient without
knowing that the home care is not set up or that the parents are not yet ready
to take care of the baby. Depending on the situation, it might be impossible
to discharge the baby that day, and the parents are disappointed."
Some aspects of Bisgaard's work were challenging. Babies came to the center
from all over the country. At any given time, there were patients from 10
different states. At discharge, sometimes Bisgaard had to set up home care
or arrange for ongoing medical treatments in distant locations. She had to
think everything through.
"Will they get on a plane? Do they need oxygen for the plane? It was like
putting the pieces of a puzzle together," she says.
Bisgaard recommends that anyone interested in this work first gain solid
hospital experience in the field that interests them. "It's not an entry-level
job," she says. "Get a lot of experience under your belt. A lot of the intuition
you use when dealing with families and patients needs to come from experience."
Andy Libbiter is the manager of social work at a hospital. He agrees that
volunteering in a health-care setting is an excellent way to know if you will
enjoy this type of work.
As a discharge coordinator, you will deal with families in crisis and with
people who are experiencing strong reactions of grief and loss. You must enjoy
working with people and helping people who are going through difficult times.
"This work requires a fairly mature individual," Libbiter says.
In Libbiter's workplace, discharge coordination is a shared responsibility.
Nurses, social workers, physical therapists, physicians and others all play
a role in planning a patient's discharge.
Libbiter is trained as both a nurse and a social worker. He says that the
social workers he supervises play an active role in discharge coordination.
However, they perform many other duties in addition to discharge planning,
and would be assigned to a particular area, such as emergency, psychiatry
or surgery.
Social workers try to understand the patient and the family in context.
In Libbiter's case, that means understanding how they feel about being in
the hospital. "We consider who the person is, their age, their gender, their
ethnic background, and the supports that they have. We try to understand how
the illness and the hospitalization is affecting them," he says.
"When it comes to discharge coordination, our work is time-sensitive,"
he adds. "We have to access and organize services to sick people as [efficiently]
as possible." Libbiter's team must be sure that everything is in place and
that everything will happen at the time that it is supposed to happen.
Cutbacks to health care mean that there are fewer medical resources available
for people. Sometimes there is tremendous pressure to free up beds, while
social workers in the emergency area try to provide supports in the home or
community so the person does not have to be admitted to hospital.
"People are going home sicker than they used to, or sometimes they are
going to a senior care facility and will not return home again," Libbiter
says, adding that this is his own opinion. "We try to help them adjust to
these things. We try to help them deal with the grief and loss they are experiencing."