Discharge management

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Discharge management (also care transfer or transfer management) is a care management tailored to the patient with the aim of providing seamless, cross-sector care after discharge or transfer from a health facility, i. d. Usually a hospital to ensure. Discharge management is a team-oriented, multi-professional task, as elements from medicine, nursing, rehabilitation and aspects of social affairs must be included both in the assessment and in the organization of care for the period after an inpatient stay.

Even before discharge, the necessary medical information is sent to the organizations and facilities that follow up, in order to ensure the flow of information and the necessary preparation.

The discharge management is intended to ensure the continuity of care at the interfaces and to introduce improved communication between the outpatient and inpatient care areas involved. To this end, it is planned to strengthen the patient's claim to care management (Section 11 (4) SGB V) with the inclusion of discharge management as a defined service of the hospital (Section 39 (1) SGB V) and to commission the state associations of health insurance companies and hospitals, to regulate the details of this regulation in corresponding contracts according to § 112 SGB V.

Practice has shown that patients who need an inpatient stay due to an acute event (stroke, heart attack, accident, etc.) or a derailed underlying disease (e.g. COPD, heart failure, dementia, etc.) still need follow-up care different efforts of the hospitals for the patient in his care reality is not sufficiently regulated and no structured discharge management takes place.

Goal setting

On the basis of a nursing assessment (current status) to be created in the relocating facility , continuous post-inpatient care is to be guaranteed through cross-sector treatment and care and consequential damage and costs due to supply interruptions are to be avoided. With a planned and coordinated transfer, patients can be discharged earlier, while the resident doctors can optimize the treatment while at the same time relieving the organizational burden. The outpatient care services or the subsequent facility benefit from the improved coordination and can optimize their human resources. Depending on the definition and objectives, these objectives are aimed at through different measures, or the understanding of the transition from care to nursing is broader or narrower.

Legal basis

Section 39 (1a) SGB V - hospital treatment: “Hospital treatment includes discharge management to support cross-sectoral care for the insured during the transition to care after hospital treatment. […] Discharge management and the collection, processing and use of personal data required for this purpose may only take place with the consent of and prior to informing the insured person. [...] "

terms and definitions

Various terms are used within nursing to describe the nursing measures for integrating care before, during and after the discharge of a patient. Uniform terms and definitions for this area cannot be derived from the specialist nursing literature.

Care transfer

Nursing transition generally describes the structural and organizational measures to ensure post-inpatient care. Nursing is primarily responsible for advisory and management tasks, while the transfer of care includes the control, moderation and accompaniment of the process of transferring the patient into a new environment. In 1997, the German Professional Association for Nursing Professions (DBfK) defined not only nursing advice and guidance for patients, but also the early and professional procurement of remedies and aids , as well as the provision of short-term care places to avoid incorrect occupancy in acute hospitals as tasks of care transfer.

Transitional care

The term “ transitional care ”, which is largely uniformly understood and used in Austria , is defined based on Böhm , who has integrated a concept for transitional care into his psychodynamic care model. The transitional care does not begin shortly before discharge, but begins with the admission. In addition to the organizational measures, personal care services are also understood to include, for example, the training of relatives, information about the healing process and the immediate accompaniment of the patient in the home environment. It essentially corresponds to the definition of care transition used in Germany, while the term transition care used in Germany is used on the one hand in the sense of short-term care or is used based on the Böhm concept.

Transition maintenance

The transitional care is a process that defines the organizational and structural measures Care Transition and thus the transition from one hospital to another nursing care - is intended to facilitate - inpatient or outpatient. Transitional care can also support the discharge of a person in need of care from the hospital to their home environment. Transitional care is intended to create a connection between the hospital, social facilities and, if necessary, the patient's home. She wants to ensure that patients in need of care continue to be well cared for after they have been released from hospital, nursing home or outpatient care. In particular, after discharge from the hospital, this should also avoid re-admission, which could be necessary again at short notice due to insufficient nursing and medical care (“revolving door effect”).

Bridge maintenance

The bridge care concept, which was developed in Baden-Württemberg in the 1980s and implemented in standard care, is used, in particular, to enable oncological patients to receive care at home that is similar to the level of care in an inpatient environment. In addition to the tasks of transition, bridge care also monitors the efficiency of care in the outpatient area, ensures psychosocial care for the sick and symptom control.

Discharge planning / discharge management

The terms discharge planning and discharge management are used in more recent publications. These terms are intended to emphasize the multi-professional and interdisciplinary approach to transitioning care. On this subject, the German Network for Quality Development in Nursing (DNQP) formulated the expert standard discharge management in Germany in 2002 . This should not regulate the organization of the discharge in detail, but rather optimize the existing approaches to a systematic patient discharge, emphasizes the coordination function of the nursing staff and the multidisciplinary approach.

Discharge planning in case management

In the Anglo-American region, discharge planning is of great importance in nursing practice and research, not least because of its importance for cost containment in the health care system. The general definition is essentially similar to the German understanding of care transfer, with an additional focus on avoiding unnecessary hospital stays through the best possible home care. A distinction can be made between planning Discharge (engl. For Entlassplanung), wherein the discharge from the stationary area also means the completion of the care situation and -Need and the Transitional planning (engl. Transitional planning) at which the transition from a maintenance environment in another or the transition to another level of care is planned. Since the 1980s, the area of ​​expertise that was previously exclusively assigned to the discharge planner has been assigned to the transition to the area of case management . The care does not end with the transfer, but goes well into the post-inpatient phase and includes outpatient resource mobilization, multidisciplinary coordination and patient care through the use of scientifically based techniques of patient-oriented case management when transitioning from one care level to another.

Discharge prescription

In October 2017, the discharge prescription was introduced, with which hospital doctors can prescribe drugs or aids. Discharge prescriptions may only be supplied by pharmacies within three working days at the expense of the GKV, whereby the day of issue already counts. The prescription of drugs based on discharge prescriptions is limited to N1 packs; if this is not on the market, a pack can be prescribed whose pack size does not exceed the smallest standard size. Discharge prescriptions may only be issued by doctors who have completed specialist training.

literature

  • Sabine Dörpinghaus, Frank Weidner: transition and case management in nursing . Series of publications by the German Institute for Applied Nursing Research eV Nursing Research. Schlütersche, 2004, ISBN 3-89993-128-9 .

Web links

Individual evidence

  1. ^ A b Sabine Dörpinghaus, Frank Weidner: Transfer and case management in nursing . Series of publications by the German Institute for Applied Nursing Research eV Nursing Research. Schlütersche, 2004, ISBN 3-89993-128-9 , p. 27-40 .
  2. ↑ In some writings, the term care transition is written as a care transition , separated by a hyphen
  3. ^ Discussion paper of the DBfK: Nursing transition in hospital , 1997, page 5
  4. ↑ Described in Erwin Böhm: Is today Monday or December? Experience with transitional care . Psychiatrie-Verl., Bonn 1992, ISBN 3884140620 , page 112 ff or under the title: Erwin Böhm: Nursing - Bridge in everyday life
  5. ^ Osnabrück University of Applied Sciences: Discharge management in nursing.
  6. ↑ Kimberley Dash, Nancy C. Zarle, Lydia O'Donnell: Discharge Planning and Nursing Transfer . Urban & Fischer Verlag, 2002. ISBN 3-437-26330-7
  7. ↑ S Kranzle, Ulrike Schmid, Christa Seeger: Palliative Care: Handbook for care and support. Springer, 2009, ISBN 3642013244 , page 185.
  8. ↑ Quotation from the preamble of the expert standard discharge management in nursing: “The expert standard does not regulate the organizational procedure of discharge management within the respective facilities (agreements in direct form between all parties involved or the use of a coordinating mediation body). Rather, he takes into account the fact that many facilities already have approaches to systematic patient discharge that can be further optimized with the help of the expert standard. Nonetheless, with reference to international studies, the standard assumes that in the discharge process, the nurse takes on the decisive coordination function due to their proximity to patients and relatives. However, that does not mean that she does all the discharge management steps herself. A successful discharge management can only multidisciplinary cooperation be achieved in the other professions, such as medicine, social work, physiotherapy, occupational therapy and psychology perceive their share. "In: German Network for Quality Development in Nursing (ed.): Expert standard discharge management in of care - development, consent, implementation , 2002
  9. ↑ The Anglo-American understanding of the concept of case management it goes beyond that used in German-speaking terminology of case management also
  10. ^ Toni G. Cesta, Hussein A. Tahan: The Case Manager's Survival Guide: Winning Strategies for Clinical Practice . 2nd Edition. Elsevier Health Sciences, 2002, ISBN 0-323-01688-X , Transitional Planning and Case Management, pp. 113-116 .
  11. ↑ Kimberley Dash, Nancy C. Zarle, Lydia O'Donnell et al .: Discharge planning, transition care, Elsevier, Urban & Fischer, 2000, ISBN 3861266148 , page 10
  12. ↑ Julia Borsch: What pharmacists need to know about the discharge prescription . In: DAZ.online . September 29, 2017 ( deutsche-apotheker-zeitung.de [accessed September 30, 2017]).