Become a Creator today!Start creating today - Share your story with the world!
Start for free
00:00:00
00:00:01
How to Successfully Discharge a Patient
272 Plays9 days ago
Hand Therapy Academy welcomes Allison to the show as she and Miranda discuss the process of successfully discharging a patient. They share tips, strategies, and insights on how to ensure patients leave therapy confident and prepared.
Recommended
Transcript
Introduction and Professional Background
00:00:05
Miranda Materi
Hi, I'm Miranda. All
00:00:07
Allison Johnson
And I'm Allison, and we are Hand Therapy Academy.
00:00:11
Miranda Materi
right, thanks, Allison, for joining us today. We have Allison, who's been a therapist for six years and a CHT for three years, and she works um at our private clinic in Mesa, Arizona. So thank you for joining us today.
00:00:22
Miranda Materi
Yeah,
00:00:23
Allison Johnson
Yeah, you're welcome. Excited to be here.
Challenges in Patient Discharge
00:00:26
Miranda Materi
and so we, um for this, we just have our staff team or team members come up with common things that they may encounter or things that um they want to discuss and put out there. And so go for Alison.
00:00:39
Allison Johnson
Okay, well, something i kind of wanted to talk about, because even after being a therapist for six years, this is something I still struggle with, um is discharging patients that don't want to be discharged.
00:00:51
Allison Johnson
um Whether it be they've reached a plateau with therapy, or maybe um they need to look into other options, and any kind of scenario, it's hard for me to tell someone they're done.
00:01:03
Miranda Materi
that That is very hard, especially when they don't want to be done.
00:01:08
Allison Johnson
don't want to be done. Yes.
00:01:10
Miranda Materi
yeah The ones that don't want to be done. So I think this is something that it's hard for me
Managing Patient Expectations
00:01:15
Miranda Materi
as well. And I think there's a few things that I've done over my career that helps with it And I think one thing is establishing early on that there is an end to the relationship, right? So sometimes I think patient, and I think this is done in mental health practices, you know, when you go to see a psychologist or a psychiatrist or anything like that, you establish that there's going to be an end date.
00:01:38
Miranda Materi
So, and that end date doesn't mean, you know, we're giving up on them or we hope that, you know, but I think establishing that early on, like, Hey, this is typically ah about how long for this type of condition it'll last.
00:01:51
Miranda Materi
Um, And so, and and then like talking about it frequently, right? Like you're about 50% there or 75% there. And the closer they get, the more you're bringing it up and the more you're talking about about it.
00:02:07
Miranda Materi
Do you have anything like specific that happened or?
00:02:11
Allison Johnson
Um, a couple things.
Case Study: Patient Plateau
00:02:14
Allison Johnson
um i tried to discharge a patient, we have been seeing her for almost a year, and it's been a year since her injury.
00:02:14
Miranda Materi
this
00:02:23
Allison Johnson
And the over the last couple of progress notes, she has kind of reached that plateau with progress. She wasn't making any gains in range of motion, strength, function, per the quick dash. And so I tried to talk to her about Um, just that she wasn't making any more progress with therapy, maybe go back to her doctor to talk about other options.
00:02:43
Allison Johnson
Um, and she was very upset about that. Um, but I think that's a good point. It's not something I use. I don't usually talk about discharge at the first visit. I think that would be, I think that's a great idea and would be really helpful just to give someone, you know, so they know what's going to be happening throughout the whole process.
00:03:01
Miranda Materi
Right. So especially, you know, if it's like a complex case, I think a lot of times patients really get, it becomes a part of their life, right? Even the social part of their life. ah And it feels good, right?
00:03:12
Miranda Materi
Usually I feel like coming to therapy is a good, positive place. So sometimes people lean on it, even not just to recover from their injury, but also, you know, it's a good place for connection.
00:03:25
Miranda Materi
And I think a lot of people
00:03:25
Allison Johnson
Totally.
00:03:26
Miranda Materi
a lot of our society and our community now lacks a lot of connections. So I think, you know, therapy
Post-Discharge Support
00:03:33
Miranda Materi
helps with that. And so I think bringing it up early is good. Another thing I was thinking about when we were, or when we were talking about it is um just making sure that the patient knows that you're not giving up on them too, which I know you've already do like an incredible job of this. So this is just more for everyone. I think sometimes when you tell the patient you're done, it feels like all hope, you know, for some of them, it feels like, oh, that's, that's it for me. You know, um, no one plays many or I'm never going to get better. And I think just having that saying like, Hey, um, I'm still here. I'm not going anywhere. if your hand gets worse or, you know, we'll just take a break from therapy ah and we take a couple of weeks off and see how you do.
00:04:19
Miranda Materi
Um, and then go ahead.
00:04:19
Allison Johnson
Yeah, that's a no, that's a good one too.
00:04:22
Miranda Materi
Sorry.
00:04:24
Allison Johnson
And I i try
Transition Strategies
00:04:25
Allison Johnson
to do that ah really with any, when I discharge, I'm always like, you know, where to find me and make sure they even have my email address. They can email me questions if something comes up, but I think that's a really good point too.
00:04:35
Allison Johnson
That can be helpful that I'm still here.
00:04:36
Miranda Materi
Yeah, I think, yeah, just not like saying, hey, this is over forever, even though, you know, that is ultimately the goal, right? We want them to get better and go on and and be successful and, you know, accomplish their goals. But sometimes that's that's hard to do.
00:04:52
Allison Johnson
Yeah, totally. um And then I think ah another tip, maybe you have given me at another point or somebody was um maybe first start with like decreasing their frequency of care.
00:05:04
Allison Johnson
i did do this with somebody recently who I know is going to be hard to discharge and that went over pretty well. i was like, okay, we did a progress note. you're You've maintained, you know all of this, um what we've done so far, what let's go maybe once every other week or every two weeks and see how that goes.
00:05:22
Miranda Materi
And how did that go?
00:05:22
Allison Johnson
And it went well, actually. It went really well.
00:05:25
Miranda Materi
Yeah, I think.
00:05:25
Allison Johnson
Oh, yeah, great idea. um as she did say, and if it doesn't go well, can we increase the frequency again? And I said, yes. Yes, we can.
00:05:35
Miranda Materi
Yes, we can.
00:05:36
Allison Johnson
true.
00:05:37
Miranda Materi
I also think it's helpful if you have the referring provider on board too, you know, like
Role of Referring Providers
00:05:43
Miranda Materi
if it can come from the team.
00:05:43
Allison Johnson
that's
00:05:45
Miranda Materi
So sometimes, you know, in the past I've like texted, I know the patient's seeing the doctor and i'm like, Hey, this is where we're at with therapy. um And sometimes the physician will help, you know, with that process as well saying, yeah, you've reached your max benefit. I'm not going to write a script or an order for you anymore.
00:06:01
Allison Johnson
Oh yeah, that's a great idea I never thought of. Yeah. Just so it seems like everybody's on the same page.
00:06:05
Miranda Materi
Yeah.
00:06:08
Miranda Materi
Yeah. And as we should be, right?
00:06:10
Allison Johnson
Totally. Yeah.
00:06:11
Miranda Materi
yeah
00:06:11
Allison Johnson
So that makes sense.
Emotional Connections in Therapy
00:06:12
Allison Johnson
so I had somebody else who was, we did a private show. I'm like wow, you've reached all your goals. You told me you have no more pain, all these things. And I'm like, so like are you ready to be finished with therapy? And she's like, what do you mean?
00:06:25
Allison Johnson
No. And I'm like, no. Like, what are your goals you want to continue to work on?
00:06:27
Miranda Materi
but so
00:06:30
Allison Johnson
she like couldn't come up with anything, but like i wanted to continue coming. Like, okay.
00:06:35
Miranda Materi
As a you you, you're just too awesome.
00:06:36
Allison Johnson
Oh, I got to start being meaner to people.
00:06:40
Miranda Materi
I know. It's definitely so nice and welcoming, you know?
00:06:42
Allison Johnson
true. Yeah. Cause yeah.
00:06:46
Miranda Materi
No, I think it's hard. I think culturally we don't connect a lot. You know, we're all like on our phones and computers and therapy is a place where people really connect.
00:06:53
Allison Johnson
so true yeah because yeah That's such a good point. I never thought of either.
Life After Therapy: Setting New Goals
00:06:58
Miranda Materi
Yeah, and maybe it's even you know helping them establish those goals for when you're done. Like, hey, where you know I think as therapists and especially as OTs, we're like really supposed to be holistic providers, right?
00:07:10
Miranda Materi
So um addressing some of those psychosocial aspects while we're you know doing, I know they're here for hand therapy, but it's easy to say, oh, you know what, i can how are you gonna fill your time? What are some hobbies or anything you're interested in doing or are there people you're interested in connecting with as the next chapter?
00:07:24
Allison Johnson
that's a great question. Yeah, that's a great idea. Like when you start talking about what they're going to fill their two hours more a week of that they're not coming to therapy.
00:07:34
Miranda Materi
Yeah, like, yes. what What are you going to do with that time? you know.
00:07:37
Allison Johnson
Yeah, that's a good point. Yeah, that's all very helpful.
00:07:42
Miranda Materi
All right. first So thanks for joining us, Allison. um For more tips, you can reach out to us at Hand Therapy Academy or our email info at Hand Therapy Academy.