discharge in order to do so, or requiring the patient to transfer to a different setting from where he/she was admitted from primarily due to the delay in making appropriate arrangements. The comparatively short average length of stay of a short term acute care hospital inpatient necessitates prompt attention to patients’ discharge planning needs in that type of hospital. Failure to complete the evaluation in a timely manner could make it more difficult to implement the patient’s final discharge plan, and/or may cause an unnecessary delay in the patient’s discharge from the hospital. While other types of hospitals with a longer average length of stay may be able to complete the evaluation at a later point after admission, they too must complete it on a timely basis to avoid delays in discharge.
Where a team approach is utilized by the hospital in developing the discharge planning evaluation, there must be a process to promote efficient collaboration among team members to complete the evaluation in a timely manner. Changes in patient condition throughout the hospitalization warrant adjustments to the discharge plan.
(6) §482.43(b)(6) - The hospital must :
a. discuss the results of the evaluation with the patient or individual acting on his or her behalf
b. include the discharge planning evaluation in the patient’s medical record for use in establishing an appropriate discharge plan
Interpretive Guidelines:
§482.43(b)(6)
The results of the discharge planning evaluation must be discussed with the patient or the patient’s representative. Documentation of this communication must be included in the medical record, including if the patient rejects the results of the evaluation. It is not necessary for the hospital to obtain a signature from the patient (or the patient’s representative, as applicable) documenting the discussion.
The patient or the patient’s representative must be actively engaged in the development of the plan, so that the discussion of the evaluation results represents a continuation of this active engagement. It would not be appropriate for a hospital to conduct an evaluation without the participation of the patient or the patient’s representative, and then present the results of the evaluation to the patient as a finished product, since this would place the patient in a passive position that is not consistent with the requirements of the patient’s rights CoP at §482.13(b).
The hospital must include the discharge planning evaluation in the patient’s medical record in order for it to guide the development of the patient’s discharge plan. Timely placement of the evaluation in the medical record facilitates communication among members of the patient’s healthcare team who should participate in a multidisciplinary process to develop and implement the discharge plan. The evaluation and subsequent planning process may be a continuous one and hospitals may choose not to divide the process into distinct documents. The key requirement is that the evaluation