requires demonstration of nursing practice processes and collaboration with
healthcare welfare service providers. It is also evident when a medical accident
occurs.
8.2 What Is Discharge Planning?
The nursing record guidelines published by the Japanese Nursing Association define
the nursing discharge summary as a summary of progress and information regarding
the health problems of people who require nursing. The Japan HL7 Association’s
“Terms and Conditions for Discharge” state the following: “The discharge summary
is the effective sharing of information among other departments involved, other
medical institutions, and care facilities when an inpatient is discharged, so that the
patient’s diagnosis, treatment, and care are linked appropriately. It is created at the
responsibility of the attending physician in order to be able to do so.” In Japan,
discharge summaries are created to obtain medical fees, explain them to patients’
families, issue them, and affix them to medical records, but they are not handed over
to home-care nurses.
Medicare states that discharge planning is “a process used to decide what a patient
needs for a smooth move from one level of care to another.” The actual process of
discharge planning can be completed by a social worker, nurse, case manager, or
others. Ideally, and particularly for most complicated medical conditions, discharge
planning is performed via a team approach.
Discharge planning involves the following:
Evaluation of the patient by a physician, nurse, home-care nurse, medical social
worker, pharmacist, physiotherapist, occupational therapist, case manager, or
others.
Discussion with the patient or his/her family representative.
Planning for homecoming or transfer to another care facility.
Determining whether caregiver training or other support is needed.
Referrals to a home-care agency and/or appropriate support organization in the
community.
Arranging follow-up appointments or tests.
Coordination of available local and welfare services.
Emphasis placed on discharge planning varies across countries. In the U.S., it is
mandatory for hospitals participating in the Medicare and Medicaid program
(U.S. Department of Health and Human Services, 2013). In the United Kingdom,
the Department of Health has published guidance on discharge practice for health
and social care (U.K. Department of Health, 2010). Clinical guidance issued by
professional bodies in the United Kingdom (Future Hospital Commission 2013), the
United States (U.S. Department of Health and Human Services, 2013), Australia
(Lim, Chong, Caplan, & Gray, 2009), and Canada (Health Quality Ontario, 2013) all
highlight the importance of planning discharge as soon as the patient is admitted,
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K. Katsuyama et al.
healthcare welfare service providers. It is also evident when a medical accident
occurs.
8.2 What Is Discharge Planning?
The nursing record guidelines published by the Japanese Nursing Association define
the nursing discharge summary as a summary of progress and information regarding
the health problems of people who require nursing. The Japan HL7 Association’s
“Terms and Conditions for Discharge” state the following: “The discharge summary
is the effective sharing of information among other departments involved, other
medical institutions, and care facilities when an inpatient is discharged, so that the
patient’s diagnosis, treatment, and care are linked appropriately. It is created at the
responsibility of the attending physician in order to be able to do so.” In Japan,
discharge summaries are created to obtain medical fees, explain them to patients’
families, issue them, and affix them to medical records, but they are not handed over
to home-care nurses.
Medicare states that discharge planning is “a process used to decide what a patient
needs for a smooth move from one level of care to another.” The actual process of
discharge planning can be completed by a social worker, nurse, case manager, or
others. Ideally, and particularly for most complicated medical conditions, discharge
planning is performed via a team approach.
Discharge planning involves the following:
Evaluation of the patient by a physician, nurse, home-care nurse, medical social
worker, pharmacist, physiotherapist, occupational therapist, case manager, or
others.
Discussion with the patient or his/her family representative.
Planning for homecoming or transfer to another care facility.
Determining whether caregiver training or other support is needed.
Referrals to a home-care agency and/or appropriate support organization in the
community.
Arranging follow-up appointments or tests.
Coordination of available local and welfare services.
Emphasis placed on discharge planning varies across countries. In the U.S., it is
mandatory for hospitals participating in the Medicare and Medicaid program
(U.S. Department of Health and Human Services, 2013). In the United Kingdom,
the Department of Health has published guidance on discharge practice for health
and social care (U.K. Department of Health, 2010). Clinical guidance issued by
professional bodies in the United Kingdom (Future Hospital Commission 2013), the
United States (U.S. Department of Health and Human Services, 2013), Australia
(Lim, Chong, Caplan, & Gray, 2009), and Canada (Health Quality Ontario, 2013) all
highlight the importance of planning discharge as soon as the patient is admitted,
166
K. Katsuyama et al.