Discharge Workflow

A discharge occurs when a patient demonstrates significant progress in their recovery, completes treatment, or can no longer benefit from continued care at the facility. Discharges may also occur if a patient is unable to meet financial obligations or if insurance no longer covers further treatment at the facility. 

Establishing a seamless discharge process is crucial for ensuring that patients transition smoothly from treatment to the community or to another facility that provides a lower level of care. A well-coordinated transition positions the patient to sustain their recovery and achieve long-term success.

Required Permissions: Admin, Tech, Therapist, Case Manager, Nurse, Doctor, Records Admin, and Super Admin.

Discharge Workflow Video 

Best Practice Workflow Steps

Let's review Kipu EMR's best practice workflows to prepare for discharge.

1. Discharge [Completed Treatment or Episode of Care]

A planned discharge ensures a smooth transition from the facility to the community or another healthcare setting.

1. Patient Meets Discharge Criteria: When a patient receives Substance Use Disorder (SUD) services, staff can utilize the ASAM Discharge form from Kipu's baseline to document required level of care changes, confirm discharge criteria, and apply clinical judgment.

• Readiness for Change: Add the ASAM Discharge evaluation using the centralized documentation icon to enter the level of care change and criteria met along with clinical judgment.
  
• Insurance Coverage/Private Pay: Confirm that financial considerations, such as insurance coverage or private payment, align with the discharge plan.
• Physician’s Order for Discharge: Obtain a physician's order confirming the patient is stable for discharge.
• Anticipated Discharge Date: Set the Anticipated Discharge Date in the facesheet. 
  

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2. Arrange Transportation: Schedule transportation to the patient's destination (e.g., home, another facility, airport, or another location) using the Scheduler feature.
   • Note: Accreditation agencies often require documentation confirming the patient has a safe and appropriate destination following discharge.
3. Finalize Aftercare Plan and Discharge Documents: 
   • Complete the ASAM discharge form, discharge instructions, treatment plan, and any other required documents.
   • Add the Discharge Summary evaluation using the centralized documentation icon and add the discharge type and date of discharge.
     
   • Close Out Financial Ledger Items: Finalize all financial transactions in the Patient Ledger, including payments and reimbursing any remaining fees.
     
4. Enroll in Alumni Group: Assign an Alumni Coordinator to the patient’s Care Team and use the Patient Portal to maintain communication, provide updates, and conduct regular check-ins. Note: Facilities enroll patients who complete treatment into an Alumni Group. Alumni staff regularly share updates, event details, and opportunities to stay connected with staff and peers. Patients may also guest speak in group sessions to inspire those currently in treatment.
5. Schedule Follow-Up Appointments: Ensure the patient has appointments with primary care and other healthcare professionals to support their ongoing recovery and care.
6. Return Personal Belongings: Return any personal belongings that have been held for the patient.
7. Doctor’s Orders Discontinued or Approved to Continue on Discharge: The patient should be given the physician-approved medications, including any refills. Controlled substances must have special permission from the physician to be given to a patient.
8. Discharge Documentation: Discharge the patient in Kipu EMR and ensure all outstanding documentation pending the patient's signature is collected by utilizing the Discharged Patients dashboard.
   
9. Track Outcomes: Use Outcomes Measurement Assessments via the Patient Portal to measure long-term recovery progress.
   

2. Voluntary Discharge - Against Medical Advice (AMA)

A voluntary discharge occurs when a patient chooses to leave a program against the recommendation of the treating clinician or provider This decision is often labeled as Discharge Against Medical Advice (DAMA), Against Medical Advice (AMA), voluntary, against, Absent Without Leave (AWOL), unsuccessfully, or premature.

1. Patient Risk for Voluntary Discharge:
   • Use Patient Flags to alert care team and staff members of potential voluntary discharge risks (e.g., flight risk).
     
   • You can also use the Messaging feature to alert the care team or staff members of AMA risk.
     
2. Attempt Retention: Care Team and staff members should counsel the patient to continue treatment.
3. Document Discharge: Add the Leaving Against Medical Advise evaluation using the centralized documentation icon for patient to sign indicating that they are leaving against clinical/medical advice.
   
   • Best Practice: Add the Discharge Summary evaluation and enter the expected discharge type and discharge date along with pertinent discharge details.
4. Close Ledger Items: Settle payments and reimbursements in the Patient Ledger.
   
5. Return Personal Belongings: Return any personal belongings that have been held for the patient.
6. Doctor’s Orders Discontinued or Approved to Continue on Discharge: The patient should be given the physician-approved medications, including any refills. Controlled substances must have special permission from the physician to be given to a patient.
7. Discharge Documentation: Discharge the patient in Kipu EMR and attempt to collect documents pending the patient's signature by utilizing the Discharged Patients dashboard.
   

3. Facility or Administrative Discharge 

A facility may discharge a patient before completing their treatment if the patient poses a danger to themselves or others or cannot make informed decisions about their care. 

1. Determine Need: Discharge may be due to safety, behavioral, or operational reasons.
2. Physician Approval: Obtain discharge orders from the provider.
   
3. Arrange Transportation: Schedule transportation to the patient's destination (e.g., home, another facility, airport, or another location) using the Scheduler feature.
• Note: Accreditation agencies often require documentation confirming the patient has a safe and appropriate destination following discharge.
4. Aftercare Plan & Discharge Documentation: Complete discharge paperwork including a discharge summary, discharge instructions, and copy of treatment plan.
   1. Best Practice: Add the expected discharge type and discharge date in the discharge summary form along with pertinent discharge details for the facility.

5. Close Ledger Items: Finalize all financial transactions in the Patient Ledger, including payments and reimbursing any remaining fees.
   
6. Complete Incident Report: Create an incident report if the patient was discharged based on behavior, safety, or medical Problems.
   • Best Practice: Incident Reports should be kept outside of the medical record unless specific to the patient’s treatment and when other Personal Health Information (PHI) is not included such as other patient’s information or issues that are not patient-related such as a staff issue.

7. Schedule follow-up appointments: Ensure the patient has appointments with a primary care doctor or another provider.
8. Return Personal Belongings: Return any personal belongings that have been held for the patient.
9. Doctor’s Orders Discontinued or Approved to Continue on Discharge: The patient should be given the physician-approved medications, including any refills. Controlled substances must have special permission from the physician to be given to a patient.
10. Discharge Documentation: Discharge the patient in Kipu EMR and ensure all outstanding documentation pending the patient's signature is collected by utilizing the Discharged Patients dashboard.
    
11. Track Outcomes: Use Outcomes Measurement Assessments via the Patient Portal to determine patient's progress and how effective was treatment for long term rehabilitation.
    
• Best Practice: Clone outcomes and use the auto-enroll feature to support specific timelines for collection of outcomes post discharge.