Discharge Process

When discharge is decided

Discharge is a clinical decision taken by the treating consultant, usually during the morning round, when the condition being treated has stabilised sufficiently for recovery to continue at home. It is not a fixed hour of the day and it cannot be reliably promised the previous evening.

Once the decision is taken, a sequence of steps has to be completed before the patient can physically leave: the discharge summary is written and checked, pharmacy and investigation charges are finalised, insurance approval is closed, the bill is settled, and the nurse hands over the instructions. This takes time. Families who expect to walk out within minutes of the doctor saying the word are almost always disappointed.

You can make it faster. Ask on the round whether discharge is likely that day, clear any pending interim bill early, and return unused medicines to the pharmacy before the final bill is generated rather than after.

How a discharge proceeds

1. Decision on the round

   The consultant confirms the patient is fit for discharge and records the instruction. Ask at this point what the follow-up plan is and whether any report is still awaited.

2. Discharge summary prepared

   The treating unit writes the summary and it is checked before handover. This is the single most important document you will take home; do not leave without it.

3. Medicine reconciliation

   The nurse and the pharmacy reconcile what the patient was taking before admission with what has been prescribed for home. Medicines that must be stopped, continued or changed are identified explicitly.

4. Pharmacy returns and final charges

   Unused medicines and consumables issued to the patient are returned to the pharmacy and credited before the final bill is generated. Investigations and procedures done on the last day are posted to the account.

5. Insurance closure

   For a cashless case, the final claim is sent for approval and the insurer's response is awaited. This step is outside the hospital's control and is the commonest reason for a discharge running late.

6. Billing clearance

   The final bill is generated, the deposit adjusted, and the balance settled or the refund initiated. Ask for an itemised bill and go through it before you pay.

7. Nursing handover and instructions

   The nurse explains the medicines, wound or drain care, diet, activity restrictions and warning signs, and confirms that the attendant has understood — in the family's own language.

8. Follow-up booking and exit

   The review appointment is fixed, films and original reports are handed over, and the identity band is removed as the patient leaves.

What a discharge summary should contain

Check the summary before you leave. If any of these is missing or wrong, ask for it to be corrected while you are still in the hospital — it is far harder afterwards.

• Patient name, identification number, age, sex, and the dates of admission and discharge
• The final diagnosis in plain terms, and any secondary conditions such as diabetes, hypertension or kidney disease
• A brief account of the course in hospital — what was found, what was done and how the patient responded
• Procedures or operations performed, with dates, and the name of the operating surgeon and anaesthetist
• Significant investigation results, including culture and sensitivity reports where antibiotics were used
• The complete discharge medication list with dose, frequency, route and duration for each medicine
• Which pre-admission medicines are to be continued, and which have been stopped or changed and why
• Diet, wound care, physiotherapy, activity restriction and any driving or work restriction
• The follow-up date, the department and the consultant, and any test to be done before that visit
• Warning signs that should bring the patient back immediately, and the fact that 108 should be called for an emergency

What to collect before you leave the building

• The discharge summary — and a copy for yourself if you are handing the original to an insurer or employer
• The final itemised bill and the payment receipt, kept safely for reimbursement or tax purposes
• Original laboratory reports, scan reports, films and CDs belonging to the patient
• The discharge prescription and the medicines purchased against it
• The follow-up appointment slip with the date, department and consultant
• Any implant identification card, device certificate or histopathology reference number
• Personal belongings from the bedside locker, and any items handed to the nursing station for safekeeping

Discharge against medical advice, honestly explained

Sometimes a family decides to take a patient home before the treating team considers it safe — because of cost, because of a family obligation, because of a preference for treatment elsewhere, or simply because they have lost confidence. This is recorded as discharge against medical advice, and you have the legal right to make that choice for yourself or, as the authorised representative, for the patient.

What we owe you in return is honesty rather than pressure. Before you sign, the treating doctor will tell you what specifically is likely to happen if the patient leaves now, how probable it is, and what could be done to reduce that risk — including whether a transfer to another hospital would be safer than going home. If cost is the reason, say so plainly; there may be an option that has not been discussed, and the billing desk can look at it.

A discharge against medical advice does not close the door. The patient can return at any time, will be treated without recrimination, and is entitled to a summary of the treatment given so far. Ask for that summary — leaving without any document is the worst version of this decision, because the next doctor then has to start from nothing.