Leaving the hospital safely after COVID-19

By: Kirsten Lewis, Think Research VP R&D, CNephC, BSc, MN and Dianne Tomarchio, Manager of Quality Improvement and Clinical Standardization at Scarborough Health Network

When patients are admitted to the hospital with COVID-19, they spend weeks isolated from their loved ones, fighting the disease. It’s often a harrowing experience. Those with the most severe illness undergo intubation and ventilation and are often given paralytic drugs to give their bodies the best chance of beating the illness. For those who recover and are well enough to leave the hospital, it’s an important victory. But, their road to recovery remains long and uncertain.   

We heard from patients that when they do return to the community, it can be daunting. Families worry that we’re sending patients home before they’re necessarily fully recovered. People wonder if they may still be contagious. Securing transportation home often proves difficult. 

We heard from colleagues on the frontlines of the pandemic that one of the biggest challenges they face with COVID-19 is knowing when and how to safely discharge a patient.

We knew there was an opportunity to help.

Scarborough Health Network (SHN) developed a comprehensive Discharge Order Set — essentially a clinical playbook for healthcare professionals to help guide them through the discharge process with evidence-based best practices. Think Research jumped on board to turn it into a resource that could be accessible to hospitals anywhere. We’ve been partners for many years working on clinical content and this order set gave us another opportunity to collaborate on a project that helps support our frontline healthcare workers.  

The order set works as a checklist for doctors, nurses and other hospital staff who are responsible for ensuring a patient is able to safely return home. This tool helps to organize communication to the family doctor and others who will be supporting the patient when they leave the hospital. If they still need to self-isolate, the order set asks the clinician to confirm that the patient is able to arrange safe transportation home and that their living situation will allow them to follow proper isolation practices.

Many people who have been affected by COVID-19 belong to vulnerable populations. This doesn’t only include the elderly, but also those dealing with mental illness, poverty and inadequate housing. As needed, the order set prompts the hospital to have conversations about what the patient might need to safely continue their recovery in the community. Often the hospital can help bridge some of those gaps.

With appropriate planning, we can help prevent patients from falling through the cracks. This tool allows us to ensure that all of the people in the patient’s circle of care, including their family doctor, are aware of what happened to them in the hospital, what treatment they were given and what the next steps are. And by managing all of this information through the order set we can help decrease the likelihood that the patient will return to emergency because of a preventable issue. This is key.  

Patients will know that they’ve been sent home with good links to the community. If they require additional support, such as home oxygen therapy or a follow up with a respirologist, the order set will account for these special considerations. 

Frontline healthcare providers will have a tool that keeps them updated on evolving knowledge of a new disease, helping them wade through information overload and relieve additional stress.

We’re in completely new territory with this disease and there is a lot of information that changes on a regular basis. We developed this order set to best support COVID-19 patients and our frontline healthcare workers as they navigate through a difficult time. With the discharge order set, we hope to help make their lives a little bit easier.