Patient Discharge

Core Concepts

Discharge planning begins at admission

Discharge planning is the ongoing process of anticipating what the patient will need after leaving. It starts during the admission assessment: who lives with the patient, can they manage stairs, do they have transportation, what medications will they continue, what is their literacy and language, what do they already know? As the stay progresses, the team — nurse, provider, case manager, social worker, pharmacist, therapy, dietitian — refines the plan, arranging home health services, equipment, rehabilitation placement, or follow-up appointments. The nurse identifies needs, teaches, and communicates; case management and social work typically coordinate services and insurance. The division of labor varies by institution.

Discharge destinations

Patients are discharged to the setting that matches their needs: home with self-care; home with home health services (nursing visits, therapy, aides); a skilled nursing or rehabilitation facility for continued nursing care and therapy; long-term care or assisted living when independent living is no longer possible; or hospice/palliative settings when the focus shifts to comfort. The destination is a provider decision informed by the interdisciplinary assessment — the nurse's functional and home assessment feeds directly into it.

The discharge process

A typical discharge flows through several steps: the provider writes the discharge order; the team confirms the destination and arranges services, equipment, transportation, and follow-up; the pharmacist completes medication reconciliation and the nurse teaches each medication; the patient receives written and verbal instructions and demonstrates understanding with teach-back; and the nurse documents the discharge — time, instructions given, understanding, and who accompanied the patient. The discharge summary is prepared by the provider (reason for admission, hospital course, discharge diagnosis, medications, follow-up plan). The nurse's teaching documentation is part of the permanent record and is often the first thing reviewed if a problem occurs after discharge.

Discharge teaching

Discharge teaching covers: medications (name, purpose, dose, schedule, important side effects — taught one by one, not as a list); activity; diet; wound or device care; follow-up (appointments and tests); and — critically — when to call the provider and when to seek emergency care, with the patient-specific warning signs written down. Teaching is matched to the patient's language, literacy, culture, and learning style, includes family or caregivers when the patient wishes, and is verified with teach-back: the patient explains, in their own words, what they will do at home. Gaps revealed by teach-back are re-taught, not papered over. Teaching is layered throughout the stay — a little each day — rather than saved for the discharge moment.

Medication reconciliation at discharge

Reconciliation at discharge compares three lists: medications taken before admission, medications ordered during the stay, and medications prescribed at discharge — and resolves every difference. Discharge is a common point for errors: home medications may be accidentally discontinued, new medications may duplicate old ones, or the patient may not know which to restart. The nurse and pharmacist produce a clear, current list; the patient leaves with a written copy and an explanation of each drug. Patients are often encouraged to bring all their medications ("brown bag" style) so nothing is assumed.

Leaving against medical advice (AMA)

Some patients leave before the provider agrees they are ready. The nurse's role is to ensure an informed choice: assess and address the reasons (pain, fear, family obligations, dissatisfaction — some can be resolved), explain the risks of leaving without completing treatment, offer alternatives, and document objectively what was said. The patient is asked to sign an AMA form; if they refuse, that refusal is documented too. Teaching is still provided — a patient leaving AMA still deserves to know what to watch for and when to seek help. The nurse's objective documentation of the conversation is the most important protection for both patient and facility. The nurse does not hold the patient or force them to stay — the patient's right to leave governs, within the law and facility policy.

How It Works / Step-by-Step Process

1. The provider writes the discharge order; the destination and needed services are confirmed by the team.
2. Case management/social work arrange home health, equipment, transportation, and follow-up (per institution).
3. Medication reconciliation is completed; the final medication list is prepared.
4. The nurse teaches medications, activity, diet, wound/device care, follow-up, and warning signs — in layers, in plain language — and verifies with teach-back.
5. Written discharge instructions are reviewed and given to the patient.
6. The patient leaves; the nurse documents time, instructions, understanding, and who accompanied them.

Scope note: which teaching and documentation steps belong to the registered nurse versus other team members, and how AMA is handled, vary by facility policy and jurisdiction.

Common Confusions