In the final week of the placement, I was involved in the discharge planning for a patient.
I have been seeing this patient, Mr P an 80 y.o man, since the week before. There have been talks by the Drs to discharge him that week, but the date was not confirmed. I realized that I should start looking into d/c planning for the pt when the social worker approached me to enquire about the mobility status of the pt.
With Mr P, his premorbid status was independent with all his ADLs, walks more than an hr a day with a W/S or WZF. He has a history of falls. Currently, Mr P has been walking around his room with his WZF independently, and he is able to perform self care tasks in the bathroom independently. However, as his physio I wouldn’t reckon him safe when he returns to the home environment. Firstly, from my O/E, he has got delayed righting response in standing, delayed stepping response, decrease ability to weight transfer to his left, bilateral LL weakness (L> R due to residual weakness from his R CVA), and very tight bilateral gastroc & soleus (bt 0-5deg ankle DF ROM). Although he seems safe walking around with the WZF, and the nurses are very happy to let me do his self-care alone, he does have a high risk of falling if he is allowed to go back home to live alone without further rehab. Besides, Mr P had a Hx of falls and that was also the reason he was admitted to hospital, as he suffered a subdural haematoma due to a fall.
During his stay in hospital, he did made progress with PT input. From requiring assistance to STS & in standing (Normal stance, EO=3s), to independent STS & standing (normal stance, EO>30s). Thus he would definitely benefit from further rehab to make him safer.
With d/c planning, I realized that a PT has a very important say as to where the pt should go next after being d/c from the hospital. PT’s are responsible in determining if the patient is safe to go back home, in terms of mobility wise. We play an important role in caring for the future well-being of the pt and not just pure Ax & Rx during the stay in the ward. It was then that I discovered that d/c planning is actually quite a tedious process. There is a lot of contacting work that you have to go through, speaking to relevant staff of appropriate hospitals/ services to be referred to. A lot of responsibilities come with that!
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Hi Beryl,
i had the same experience as well during my placement. i did not plan ahead and think about what the discharge plans will be for the patients. i spent quite a bit of time reading up the various DC options (HITH, RITH, outpts, etc) and after having a better understanding, i was better at planning DC for my patients. it definitely comes with lots of responsiblites. But i think is really good that we can have a say and determine if the patient can get DC or not. Unlike in Singapore, if the doctors say that the patients are medically stable, the next day they are out of the hospital despite being unsafe at home.
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