How to: Know when it is time to discharge a patient
How do you know when it is indeed time to discharge a patient?
In my experience in working with a caseload of my own and also with countless other therapists, this is a topic that is difficult for many reasons. Many therapists question when is the right time and the right way to discharge.
First of all, let’s explore the reasons that could be behind the decision to possibly discharge a patient. Usually, a clinician would be considering discharge for the following reasons:
– Functional goals are achieved
– Skills are within normal limits.
– The individual or family chooses not to participate in treatment
– The individual or family relocates
– The individual or family decides to seek treatment from another facility or provider.
If you are considering discharging a patient due to skills that are within normal limits or functional goals being met, here are some things that may help you make a decision or navigate the discharge process:
1. Talk with other clinicians and if possible have another clinician work with the child for a session or at least observe for part or all of the session. Sometimes a new set of eyes can see things you may have missed.
2. Update standardized testing. If you can’t give a standardized test for reimbursement reasons or because there hasn’t been enough time to pass to retest, then you can use checklists and developmental norms guides to make sure you aren’t overlooking any skills the child should have.
3. Have a talk with the family about what it means to be discharged. I like to make sure families know that it doesn’t mean they have failed if there is a need to reinstate therapy sometime in the future. I go out of my way to make sure they know they are always welcome back even if just for a quick check in or evaluation to make sure skills and development are on track.
4. Talk with the patient and/or family about weaning off of treatment vs. stopping “cold turkey”. This weaning will give you a chance to confirm that skills are being maintained outside of the treatment sessions and clinic and will also give the patient and family a chance to make sure they are more than comfortable with the home program.
For more information about appropriate discharging make sure to check with your state rules as well as current professional association position statements.