Whilst on a neurosurgical rehabilitation ward, I was treating a 22 year old male who had multitrauma after being hit by a truck 3 months prior. He had mild dyspraxia, moderate cognitive issues and significant fractures in the pelvis and both legs that were surgically managed (NWB). Treatment consisted of muscle strengthening, stretching and coordination games, restricted by his NWB status. Over 3 weeks of seeing him on a daily basis, he showed great improvement in his strength, communication, slide board transfers and dyspraxia.
When he was finally permitted to WB, his mother immediately wanted to discharge him home to their farm. He was unable to walk, unsafe to stand independently and his strength and balance were far from adequate to be discharged. I was concerned that the mother thought she could cope at home and disturbed that his rehabilitation would be cut short, as a result a return to his pre-accident status would be highly unlikely. I was irritated that the mother was persistent on discharging him so soon.
A team meeting and a family meeting were arranged quickly to discuss this patient and his family. The patient and his mother expressed the reasons for wanting to discontinue rehabilitation so soon. It turns out they were pleased with health professionals treating him but were sick of sharing a room with one particular patient who had significant behavioural and cognitive issues. The situation was resolved with moving the other patient to a single room. He was able to continue his rehabilitation and his mother was much more settled. Despite the patient’s mother previously mentioning that she didn’t like her son sharing a room with the other patient, it was never apparent to any staff that this caused her so much frustration (since all patients complain about sharing rooms!).
To us health professionals, whether a patient is ready for discharge from a functional point of view can be obvious, but to the family/friends it may seem that the patient is ready to go home when in actual fact they aren’t. This may lead to family and patient frustration and wanting to stop treatment against all medical opinion.
I HAVE LEARNT THAT FAMILY AND TEAM MEETINGS ARE VITAL IN THE REHABILITATION SETTING AS THEY GIVE A FORUM FOR ISSUES TO BE MADE CLEAR, PLANS MADE AND ACTIONS CARRIED OUT. IN FUTURE, I WILL DISCUSS DISCHARGE PLANNING WITH THE FAMILY SO THAT WE ARE ON THE SAME PAGE AND EXPECTATIONS ARE MADE CLEAR.HOPEFULLY WITH THE CONCERNS COMMUNICATED BETWEEN YOU AND THE PATIENT/FAMILY, A SOLUTION CAN BE MADE, WHICH ULTIMATELY IMPROVES THE PATIENT’S RECOVERY.
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I agree that patients and their family can sometimes have unrealistic expectations about when a patient can be discharged. Often they do not realise how difficult it can be to manage at home. Although family meetings are important, I think it is important to discuss the subject prior to the family meeting, so the patient and family are not too shocked that none of the team thinks the patient is ready for discharge.
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