About the only aspect of leaving a hospital that is consistent among all patients is that we all do it sooner or later. Hospital discharge is the process by which you prepare to leave the hospital.
In an ideal world, hospital discharge would take place when both you and your healthcare provider think the time is right. You would be strong enough and healthy enough to handle not only the important discharge tasks and details, but also to take care of yourself once you arrive at your destination.
However, we don’t live in an ideal world. In order to understand why problems arise with the timing of hospital discharge, and what can be done about it, we need to understand how the decision is made about the amount of time you’ll be hospitalized.
Why Discharge Is Your Payer’s Decision
Before you are admitted to the hospital, your entire hospitalization and any predicted tests, procedures, and treatmentsmust be approved for payment by your payer—an insurance company or a public payer such as Medicare, Tricare, the VA, or state Medicaid payer.
To determine what they will pay for, payers rely on diagnostic codes, called ICD codes, and procedure (service) codes called CPT codes to describe what is wrong with you, and therefore what treatment or tests need to be performed to help you.
Included in those descriptions are the average amount of time you are approved to be in the hospital to complete the tasks that fall under those codes.
What “average” means is based on the insurance company's opinion on what the ideal patient, someone with no additional problems, would need. It’s not at all based on individual patients and their status.
Based on the anticipated codes that have been assigned to you, once your time is up, your payer will no longer pay for your stay. If they won’t pay, then unless you can pay cash, the hospital will send you home.
Therefore, your date and time of discharge are not based on physical readiness. They are based on coded payments which may be in direct conflict with your readiness.
When Patients Should Stay Longer
Problems will crop up if you aren’t “average.” Maybe your body is having trouble healing from surgery. It’s possible you’ve gotten a hospital infection, or have been the victim of a drug error.Older people take longer to get back on their feet.
For these reasons and others, you or your healthcare provider may determine that the payer allotted time won’t be enough time for you.
If there has been an additional problem (like the infection or a drug error), the hospital may automatically try to extend payment for your stay, and you won’t ever hear about it. But that does not always happen.
There are financial reasons for you to want to stay an extra day or two, too.For example, if you need to be discharged to a skilled nursing center or rehab, Medicare won’t pay for it unless you’ve stayed at least three days.
So you may be caught in a bind.What is wrong with you—based on your diagnostic code—may mean they’ll pay for only two days. But if you are discharged in two days, you may be stuck with the cost of the other facility—possibly for months or years.
Other Reasons You May Want to Stay
It’s also possible your reluctance to leave isn’t based on your health status at all; rather it’s about the lack of caregiving support you have at home or fear that something major could happen and go unnoticed without 24/7 monitoring.
Maybe you are just lonely and you like the attention you get in the hospital. The truth is, in most cases, these are not good enough reasons to stay.
Hospitals can be dangerous places. Only the sickest of patients are found in hospitals, and along with them are found the worst of infectious agentswhich are too easy to contract.
Infections also rear their very ugly heads when the hospital personnel who care for you—healthcare providers, nurses, and others—don’t work diligently to stop their spread, which they can do by washing their handsand taking other steps to keep you safe.
Further, we know that hundreds of thousands of Americans die in hospitals every year, not from the reason they were hospitalized to begin with, rather because something that happened during their hospital stay killed them.
If you decide to fight your hospital discharge, be sure it’s because it’s absolutely necessary for your survival and does not put you at further risk from hospital-acquired problems.
Staying Longer May Cost You More
As you consider filing an appeal, don’t forget that staying longer may cost you out of your pocket more, too.You may have co-pays, deductibles, and co-insurance you’ll owe to the hospital for the extension.
How to Appeal a Discharge
Once you’ve been given a discharge date and you and your healthcare provider agree that you should extend your stay, you will want to appeal (fight) the discharge date you’ve been given.
The steps for appealing the discharge date will vary from hospital to hospital, and from state to state unless you are a Medicare patient.Medicare has a very specific process to followno matter where you live or what hospital you’ve been admitted to.
Those guidelines may also be used by the hospital for non-Medicare patients, so if you decide to appeal and you aren’t a Medicare patient, you can attempt to try to follow their instructions anyway.
Here are some generalities that may be helpful to you no matter who your payer is:
- Read the notice of discharge. Your hospital admittance should include a statement of your rights along with discharge information and how to appeal a discharge. If you aren’t provided with anotice of discharge and how to file an appeal, request one from thehospital's patient advocate and follow those guidelines.
- Talk to the QIO. The person you will be appealing to is called the Quality Information Officer (QIO). The federal government has strict requirements for the way a QIO handles discharge appeals.
- Ask about the "Safe Discharge" policy.Safe discharge is the key term Medicare uses, and you can use it, too. In your appeal, state that you don’t believe the current plan meets the needs of safe discharge as defined by Medicare. Even if you are not a Medicare patient, using the terminology may sway the decision in your favor.
The Hospital May Help Fight
Keeping in mind that hospitals only make money when their beds are full, there will be circumstances when they want to go to bat for you to help keep you there. Of course, the longer you stay, the more money they make. Therefore, you may be able to depend on them to convince your payer to keep you there.
In addition, the Affordable Care Act's Hospital Readmission and Reduction Program (HRRP) applies financial penalties to hospitals that have too many readmissions of Medicare patients. Hospitals are now under scrutiny for discharging patients too soon.
How to Prevent Hospital Readmissions
Whatever you decide, be sure it's in the best interest of your health and medical status and that the stress of the process doesn't have a negative effect on you.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
James JT. A new, evidence-based estimate of patient harms associated with hospital care. J Patient Saf. 2013;9(3):122-8. doi:10.1097/PTS.0b013e3182948a69
U.S. Centers for Medicare & Medicaid Services. Quality Improvement Organizations.
McIlvennan CK, Eapen ZJ, Allen LA. Hospital readmissions reduction program. Circulation. 2015;131(20):1796–1803.
By Trisha Torrey
Trisha Torrey is a patient empowerment and advocacy consultant. She has written several books about patient advocacy and how to best navigate the healthcare system.
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- Read the notice of discharge. Your hospital admittance should include a statement of your rights along with discharge information and how to appeal a discharge. ...
- Talk to the QIO. ...
- Ask about the "Safe Discharge" policy.
- ensure continuity of care.
- clarify the current state of the patientʼs health and capabilities.
- review medications.
- help you select the facility to which the person you care for is to be released.
- Skilled Nurse/Sub-Acute Rehabilitation. ...
- Long Term Acute Care Hospital. ...
- Medical Equipment. ...
- Community Resources. ...
- Home Health Care. ...
- Hospice. ...
- Assisted Living.
- 1) Coordinated teamwork is the key to success - ...
- 2) Automate your discharge process - ...
- 3) Let your patients know the estimated cost of treatment - ...
- 4) Keep your patients informed about the date of discharge - ...
- 5) Manage your per bed inventory efficiently - ...
- 6) Help your patients in filing an insurance claim -
If a military member is discharged, he/she can appeal the discharge, as well as appealing the characterization of the discharge, reason for the discharge, and/or reenlistment eligibility code (RE Code).What is an unsafe discharge? ›
An unsafe discharge from hospital occurs if you are discharged, or sent home, when your release from the hospital could adversely affect your health. An unsafe discharge occurs in situations including if: You are sent home prior to being properly diagnosed. You are sent home when your condition has not yet stabilized.What are the three C's in discharge planning? ›
It measures three areas of a patient's desire for participation in discharge planning, including (1) participation/communication, (2) preference, and (3) desire for information.What is a discharge protocol? ›
Hospital discharge planning is a process that determines the kind of care you need after you leave the hospital. Discharge plans can help prevent future readmissions, and they should make your move from the hospital to your home or another facility as safe as possible.Who is responsible for discharge summary? ›
The Discharge Summary is regulated by the Joint Commission (JCAHO) which is responsible for accreditation of healthcare organizations - i.e if a hospital has poorly written Discharge Summaries, they receive an audit from JCAHO.What are hospital barriers to discharge? ›
Utilizing the responses from 26 nurses, 25 internal medicine residents, and seven attending medical staff, the study found that communication gaps, lack of role clarity, and lack of resources, both in acute care and community care, are perceived as the three largest barriers to discharge.
Hospitals are often crowded and need to free up beds. Also, insurance companies often pressure hospitals to quickly discharge patients so that the medical bill does not get too big. Premature discharge occurs whenever you are discharged when it is unsafe to do so.What is a complex discharge from hospital? ›
If you need more specialised care after leaving hospital, your discharge or transfer procedure is referred to as a complex discharge. If you need this type of care, you'll receive a care plan detailing your health and social care needs. You should be fully involved in this process.What time do most hospitals discharge patients? ›
Discharge Planning Checklist
Ask a family member or friend to pick you up by noon Discharge Time is between 11 a.m. and 3 p.m. Please plan ahead and be ready. Evidence shows that if a patient is discharged earlier in the day, he or she is less likely to need to return to the hospital.
Six Sigma relies on a structured approach to uncover the root cause of a problem using the Define, Measure, Analyze, Improve and Control (DMAIC) method by: defining the problem; measuring the defect; analyzing the causes; improving the process by removing major causes; and controlling the process to ensure defects do ...What are the consequences of poor discharge planning? ›
may result in a transfer to a care setting that does not meet the patient's needs. Not addressing the whole patient (underlying depression, etc.). not tailored to a patient's level of health literacy or current health status. Poor understanding by providers that the patient's social support is lacking.How do you overturn a general discharge? ›
You can appeal a bad Discharge Review Board decision to the Board of Correction for Military Records of your branch of the service using DD Form 149, which can be found on the DOD forms website. Again, hiring a disability attorney can help you win a discharge upgrade on appeal.Can you get disability after a general discharge? ›
You may be eligible for disability benefits if you have an illness that's at least 10% disabling that appears within 1 year after discharge, and you meet both of these requirements.Can you fight an other than honorable discharge? ›
Military Administrative Separation Boards
So yes, you can fight an Other Than Honorable discharge, and you should fight an Other Than Honorable discharge. You should always exercise your right to counsel and fight it out at a board to try to get something better than an OTH.
Post-acute care may be the responsibility of hospitals in the three months after a patient's discharge. However, during these post-discharge months, the hospital has limited control over the senior patient's choices and progress.What is sufficient discharge? ›
The receipt given by the Secured Party for the purchase money paid at any sale shall be a sufficient discharge therefor to any purchaser of all or any part of the Collateral sold.
Here is a list of most types of military discharges: 1 – honorable discharge; 2 – general discharge under honorable conditions; 3 – other than honorable (OTH) discharge; 4 – bad conduct discharge (issued by special court-martial or general court-martial); 5 – dishonorable discharge; 6 – entry-level separation; 7 – ...What are the 5 D's of discharge? ›
The patients have to be able to recite the answers to the “Five Ds of Discharge:” Diagnosis, Drugs, Doctor, Directions and Diet.Which is a nurse responsibility during patients discharge? ›
It is their responsibility to ensure policies are implemented and the necessary systems and procedures are in place to allow for effective discharge planning. They must also ensure communication with the patient and their parent/carer regarding the process and estimated discharge date.When can discharge problem be assessed? ›
To be safe if the person is going home, the assessment should be done promptly (within 2 hours), with rapid (on the day) access to care and support if it is required.What is smart discharge? ›
The SMART Discharge Protocol (Signs, Medications, Appointments, Results, and Talk with me) was developed to improve care for patients and families and to improve the discharge process.What is discharge intervention? ›
Discharge interventions are defined as single or multifaceted interventions involving personal contact between the patient and their care team (i.e. hospital staff, community workers, service providers) that aim to prevent or solve anticipated problems in subsequent outpatient or post-discharge care, facilitate ...Why does hospital discharge take so long? ›
A patient might need complicated help such as in-home care, a wheelchair, or oxygen. The doctor who ordered the discharge has to sign off when everything necessary has been done, and that doctor might be doing a four-hour surgery or be otherwise busy at the moment.Who controls the release of patient information? ›
Hospitals and health systems are responsible for protecting the privacy and confidentiality of their patients and patient information. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations established national privacy standards for health care information.How long does a physician have to dictate a discharge summary? ›
Records should be assembled, analyzed, and completed within 30 days of discharge unless state law specifies another time frame. A record should be removed from the nursing station as soon as possible after discharge within 24 – 48 hours, but no more than 72 hours after discharge.What does a hospital discharge summary contain? ›
To continue to paraphrase the APTA's description: All discharge summaries should include patient response to treatment at the time of discharge and any follow-up plan, including recommendations and instructions regarding the home program if there is one, equipment provided, and so on.
- Communication. Communication was identified by all members of the team as an important factor influencing an effective discharge process. ...
- Lack of role clarity. Another important barrier identified was the lack of role clarity. ...
- Lack of resources.
Discharging people too early or without the necessary support can be unsafe and increase the risk of readmission. Delayed discharge, on the other hand, increases the risk of hospital-acquired infection, and is associated with low mood and reduced motivation, which can also increase the risk of readmission.What are the different types of discharge from the hospital? ›
- Supervised discharge.
- Deferred discharge.
- Summary of types of discharge.
- Full discharge of unrestricted patient.
- Deferred discharge of unrestricted patient.
- Wishing you a speedy recovery.
- Feel better soon!
- Sending lots of love and hugs your way.
- You're in my thoughts.
- Take extra good care of yourself.
- I miss having you around.
- You'll be feeling healthy and strong again soon!
- Praying for an easy recovery.
Discharge Time. Definition: The time the patient was discharged from acute care, left against medical advice (AMA), or expired during the hospital stay.Can you ask to be admitted into the hospital? ›
Ultimately, the physician determines whether a patient can make it to the hospital on their own or needs an ambulance. Physicians who request that a patient be directly admitted usually make bed arrangements.What happens when a patient leaves against medical advice? ›
Leaving AMA does not mean that you cannot return to the hospital for care. But if you leave against medical advice and need readmission to the hospital, you will need to go back to the ER before readmission. The emergency room is always available.How long will hospital keep someone on life support? ›
There is no rule about how long a person can stay on life support. People getting life support may continue to use it until they either recover or their condition worsens. In some cases, it's possible to recover after days or weeks of life support, and the person can stop the treatments.What is survival to hospital discharge? ›
Survival-to-discharge patients includes those transferred to a rehabilitation facility or extended care facility, and those requiring home nursing services. Adult is defined as having reached the age of 18 years.What can I use to stop discharge? ›
Bathe or shower daily and pat your genital area dry. Don't douche. Avoid feminine hygiene sprays, colored or perfumed toilet paper, deodorant pads or tampons, and bubble bath.
You can drink rice starch (water in which rice is boiled) regularly to eradicate the problem of white discharge. The starch from the rice is highly preferable when you are constantly suffering from the problem of white discharge.How do I stop self discharge? ›
Storing batteries at lower temperatures thus reduces the rate of self-discharge and preserves the initial energy stored in the battery. Self-discharge is also thought to be reduced as a passivation layer develops on the electrodes over time.How do you get dishonorable discharge? ›
Dishonorable discharges are handed down for what the military considers the most reprehensible conduct. This type of discharge may be rendered only by conviction at a general court-martial for serious offenses (e.g., desertion, sexual assault, murder, etc.) that call for dishonorable discharge as part of the sentence.How much discharge is too much? ›
A normal amount of vaginal discharge in a 24-hour period ranges from 1-4 milliliters. This is just under a teaspoon at the most. You may notice more discharge before or during ovulation. Otherwise, consistently seeing a lot more discharge is considered excessive and you should investigate it further.What causes too much discharge? ›
Excess vaginal discharge can occur as a result of arousal, ovulation, or infections. Normal vaginal discharge ranges in color from clear or milky to white. The consistency of vaginal discharge also varies from thin and watery to thick and sticky. Generally, healthy vaginal discharge should be relatively odorless.How much discharge is normal? ›
How Much Discharge Is Normal? According to studies and textbooks, women generally produce anywhere from 1 to 3 ml of vaginal discharge in 24 hours. The amount tends to vary on a day-to-day basis, often affected by factors like ovulation and birth control.What your discharge is telling you? ›
Vaginal discharge that is chunky, foamy or accompanied by itching and changes in color may mean you have an infection. Color: Vaginal discharge is healthy if it's clear, milky white or off-white. Dark yellow, brown, green or grey discharge may indicate an infection or other issue.What does black discharge means? ›
Black discharge may mean that older blood is leaving the uterus or vaginal canal. Heavy vaginal discharge of any color with a foul odor is also a symptom of these infections. Other symptoms include: bleeding during or after sexual intercourse. painful urination.What is self-discharge from hospital? ›
Introduction. This leaflet is designed to provide carers/family and friends with information if the person they are caring for discharges themselves from hospital against medical advice. This is known as self-discharge. Someone may be able to self-discharge if they are believed to have capacity.Can patients discharge themselves? ›
You have the right to discharge yourself from hospital at any time during your stay in hospital. If you want to complain about how a hospital discharge was handled, speak to the staff involved to see if the problem can be resolved informally.
Since the cell is at open circuit, no current can flow in the external circuit; instead, the continuous shuttling process causes the cell to self-discharge. In principle, this parasitic reaction is completely reversible.Is depression an honorable discharge? ›
If you develop anxiety or depression while serving in the military, it may be grounds for a medical discharge or retirement. The outcome depends on factors including the severity of your symptoms and how they respond to treatment.What is a punitive discharge? ›
A discharge awarded by sentence of a court-martial. There are two types of punitive discharges: (a) Bad conduct. A separation from the naval service under conditions other than honorable. It may be effected only as a result of the approved sentence of a general or special court-martial.Is mental health a dishonorable discharge? ›
In the military's scheme of things, serious disorders such as major depression, anxiety or schizophrenia may be grounds for medical discharge or retirement, usually depending on their severity and amenability to treatment.