Scott Webb (Host): Welcome to Stoughton Health Talk. I'm Scott Webb. The hospital discharge process may lead folks to have more questions than answers, and my guest today has many of the answers to these important questions. I'm joined today by Dr. Angie Ingraham. She's a board-certified patient advocate, and founder of True North Patient Advocates. Angie, it's nice to have you here today.

Dr. Angie Ingraham: Thanks so much for having me, and I'm looking forward to our discussion.

Host: Yeah, I'm looking forward to this as well. I haven't been in the hospital in a long time, but I've had family members who have been, and we've had these questions. So, it's great to have you here, have your expertise, if you will. As I mentioned, folks have questions, you have the answers. That's why you're here. So, why are hospital discharges such high risk moments for patients and families?

Dr. Angie Ingraham: I think if I can sum it down to three points, it's really communication, coordination, and change. So, there are so many details and factors that go into hospital discharge processes that we need to make sure that communication is really on spot. The coordination of healthcare today is so complex, and especially coordinating from the hospital to home makes it even more complex. And then, this element of change where patients are just not the same as they were in or after the hospital as when they came into the hospital. So, it's really all of those factors playing into why there's such a high risk transition of care.

Host: Yeah. And I'm sure, Angie, that you know nobody, especially, you know, the providers, but the patients and families, nobody wants to feel like it's a one-size-fits-all, right? They want to feel like this whole process, if you will, is sort of personalized, right?

Dr. Angie Ingraham: Absolutely. Absolutely.

Host: So, what are some of the common mistakes or oversights that happen during hospital discharge, especially when going home?

Dr. Angie Ingraham: So, I think the one primary mistake is that people don't think about being discharged when they get admitted to the hospital. Steven Covey says, begin with the end in mind. So, I want people to think about their discharge from the moment that they step into the hospital, because that can just set you up for that proper discharge at the end, things such as medication changes. So, are you going home on the same medications as when you came into the hospital? Are there new medications? Are there differences in doses? Are there things that you need at home that you don't have: supplies, services, caregivers? All of those things need to be set up in place before you actually go home. So that when you do get home, you have that seamless transition from hospital to home.

I think the last point is that patients and families really need clear education on discharge instructions. It's really not instructions, right? It's not like I'm going to tell you as a provider, "These are the things to do," it has to be an understanding, it has to be a conversation. So, they need to know who to call, where they should go, what's normal, what's not normal, and what they can and can't do when they go home.

Host: That's such an interesting point. You know, it's sort of counterintuitive that the moment we arrive, or maybe when we're on the way to the hospital, we should already be thinking about, "Well, what do we do when we leave?" And so, it makes me wonder then, Angie, like, what can we do patients' families ahead of time to prepare for safer discharge from the hospital?

Dr. Angie Ingraham: Yeah. So, a lot still focuses on that communication. So , what I encourage patients and families to do is think about how you can help the healthcare provider understand what it's like at being home. So, you know, if you're in a home where all you have is steps to get into the home, your providers need to know that. Help them understand to paint that picture of what it's like at home. Who's going to be around to help you? Are you going to be able to get to the appointments that they've made for you after the hospitalization? Is someone going to be around to drive you? What is the support going to be like at home? Will someone be there to help you change dressings? And if there is someone, do they know how to do it or do they need to come into the hospital to learn that skill to support you at home? So, I think it's all about communication and painting that picture of what life is like at home for you so that the healthcare providers and staff can help to make that transition go as smoothly as possible.

Host: Yeah, I'm just picturing the steps in my home. We have pets, we have area rugs, like, the greatest hits, if you will, right, Angie, of things to maybe make sure your healthcare providers know and family members as well. Like, "Hey, let's move those rugs because I'm going to be a little unsteady on my feet," right?

Dr. Angie Ingraham: Right, exactly. Very short story, I cared for my dad. He was in a wheelchair. We only had steps to go into our house. We were fortunate we had someone come out and build a ramp the next day. But that takes planning. So, that's where I also just like how can we think about these things as far in advance from the discharge so that we can have everything appropriately arranged for when you are ready to go home.

Host: Let's talk about the role that healthcare teams-- and we like to think of them as teams-- and independent patient advocates play in making the discharge process as smooth as possible.

Dr. Angie Ingraham: Yeah. So, I think one of the best things that healthcare providers can do is to establish kind of clear discharge criteria or discharge goals for patients and families. I think too often we think of it in terms of, "Oh, you're going to be going home in X number of days." I would rather have them have the conversation of saying, "These are the things that I need to see from you so that I would feel comfortable discharging you." So, in my world as a former trauma surgeon, you know, it was: "Are you eating okay? Are you moving your bowels? Is your pain controlled? Can you get up and move around? Do all your labs, your vitals, your exam, does that all look okay?" Because then patients and families can kind of have this little checklist of, "Yes, I'm meeting these goals, I'm not meeting these things." It gives them a better idea of when they can go home.

Host: Yeah. And I'm going to go a little off script, Angie. But, you know, it seems to me having been to the hospital again with family members and things, that folks start to get a little frustrated that things seem to take a long time, that there's a lot of people coming into the room. There's a lot of paperwork, all of that. Reassure listeners that a reason for all of that, right? That it's not just red tape, it's not just paperwork, that the I's need to be dotted and t's need to be crossed, but in the best interest of the safety and health of patients, right?

Dr. Angie Ingraham: Yes, absolutely. And hospitals and healthcare providers are really looking to make those transitions as optimal as they can. They don't want you to be back in the emergency room. They don't want you to be readmitted to the hospital, and it can be very, very frustrating. It can take time. It can take time for things to get processed through insurance. Things don't happen on the weekend in an administrative capacity. And so that again, as much as we can be doing these things ahead of time or as early in the process, those approvals can get sent out, those evaluations can be done, to try to make the process go as smoothly as possible.

Host: Right. In the case of a true emergency, we don't have that time, that lead time, that preparation time. But if we know we have a surgery scheduled, something like that, we can move those rugs. We can plan ahead of course. It's been great to have you here, great to have your expertise. I just want to sort of address like folks that are unsure or maybe they feel overwhelmed during this process. What do you suggest they do first?

Dr. Angie Ingraham: I would encourage you to speak up. And I know that that's easy for me to say and hard for people to do, right? There are power differentials in the hospital and in healthcare. But trust me, your providers want to know if you're not understanding something, if something was confusing, if they need to go over something again. And in part, that's the job of healthcare providers to make sure that you do understand. And so if something isn't clear or you're feeling uncertain, please let them know, because often they don't know. And they can't help you if they don't know.

Host: I appreciate your time today. I think the common thread that I'm going to take away, and hopefully listeners will as well, is the education piece of this, but also really communication, open lines of communication, don't be afraid to speak up, right?

Dr. Angie Ingraham: Absolutely. Absolutely.

Host: That's perfect. For more information, go to truenorthpatientadvocates.com. Angie, thank you so much for being here.

Dr. Angie Ingraham: Thank you so much for having me. I really appreciate it.

Host: If you found this podcast helpful, please share it on your social channels and check out the entire podcast library for topics of interest to you. I'm Scott Webb. Thanks for listening to Stoughton Health Talk.