Discharge Navigator
The Discharge navigator must be used to discharge all patients from hospital to home or to a community care program (non-facility). The navigator is accessed from a "Discharge Transfer Gateway" that provides guidance about the correct workflow.
Discharge Transfer Gateway
A "Discharge Transfer Gateway" is available as a tab (or more menu option) within all charts opened to an inpatient encounter. A variant of the gateway also appears for emergency department encounters in the "disposition" tab.
There are three Gateway subsections, each directing prescribers navigator(s) specific particular discharge or transfer destination(s):
Discharge from Current Facility
To Home or Community Services
For patients who are being discharged from hospital, to home or to community care. Note that this includes sending to a Supportive Living (SL) or Designated Supportive Living (DSL) facility, as such a destination facility often functions like a patient's home.
Discharge as Deceased
Patients who pass away within or on arrival to a hospital encounter are "discharged", with unique documentation requirements facilitated by the Discharge as Deceased navigator.
Transfer within Current Facility
Patients shifting from one hospital service's (specialty) to another experience an Intra-facility Transfer. Such within-facility transfers may involve moving to a different ward or bed (e.g., transfer from family medicine to critical care). However, a physical move is not required (e.g., transfer from family medicine to general internal medicine on the same ward).
Send to Another Facility
Leave of Absence (LOA) – For patients who will be temporarily away from the unit, but will be returning (e.g., patient on a pass).
Inter-facility Transfer (IFT) – For patients who will be discharged and admitted to another facility, either to a facility with or without Connect Care pharmacy services. Specific subsections address requirements specific to transfers out-of-province or within-province to acute or continuing care facilities.
Discharge to Home or Community Services Navigator
All activities needed for a safe and complete discharge can be accessed from the Discharge navigator. This simplifies prescriber work and ensures that orders, medication reconciliation, documentation and follow-up tasks are coordinated.
The most important steps, in order, include the following:
Review
Check any recent test results that may not have been reviewed and note any with results not yet reported that will require follow-up.
Reconcile the patient’s problem list by marking hospital problems resolved during the admission and others that may continue as active issues for follow-up.
Action
Consider post-admission community support needs which may affect needed orders (e.g., home care) or follow-up arrangements.
Clean up the patient’s orders to make subsequent medication reconciliation and discharge ordering easier.
Place discharge orders by indicating which home and hospital medications to continue and adding any new medication, referral or outpatient testing orders.
Documentation
Consider any patient instructions (e.g., appointment particulars) or education supports (e.g., medication, disease or procedure guides) to include in the After Visit Summary.
Prepare a Discharge Summary note.
Similar to the Admission Navigator, it is important to complete all sections. Failing to do so will prevent completion of the workflow. Doing so in the indicated order will save time when later steps (e.g., discharge summary) take advantage of information entered in earlier steps (e.g., medicatation reconciliation).