Include the patient and family as full partners in the discharge planning process.
Discuss with the patient and family five key areas to prevent problems at home:
1. Describe what life at home will be like
2. Review medications
3. Highlight warning signs and problems
4. Explain test results
5. Make followup appointments
Educate the patient and family in plain language about the patient’s condition, the discharge process, and next steps throughout the hospital stay.
Assess how well doctors and nurses explain the diagnosis, condition, and next steps in the patient’s care to the patient and family and use teach back.
Listen to and honor the patient’s and family’s goals, preferences, observations, and concerns.
This process will include at least one meeting to discuss concerns and questions with the patient, family of their choice, and [identify staf