Trauma Guideline Manual - SUNY Upstate Medical University

Trauma Guideline Manual______________SUNY Upstate Trauma Center141PRACTICE GUIDELINES: DISCHARGE CRITERIAOBJECTIVE:Establish minimal discharge criteria to assure safe transfer of care to home or a skilled nursingfacility.DEFINITION:Discharge: The transfer of care from the acute care setting to home, supervised environment,skilled nursing facility, rehabilitation center or transitional care facility.GUIDELINES:1. For discharge to home, the following conditions must be met:a. Tolerating PO diet or tube feeds.b. Pain managed with oral medications.c. T 22% (consider FeSO 4 ); WBC not increasing.f. Able to ambulate with assistance that is available OR has available help if to be kept atbed rest.g. If needed, home health nursing has been arranged.h. Patient or family understands discharge plan.i. Method of follow-up clearly identified (clinic, primary care, specialty service). If PCPfollow-up, then the PCP should be called by the resident or Trauma Program Manager.A follow-up letter will be sent.2. For discharge to supervised environment or skilled nursing facility:a. Tolerating PO diet, tube feeds or TPN.b. Bowel activity without significant diarrhea or constipation.c. Pain managed with oral medications.d. T 22%; WBC not increasing.g. If required, IV access good without phlebitis.h. Wounds healing.i. Care is within the scope of the receiving facility.j. Family or patient understands goal of treatment plan.3. For transfer to rehabilitation center or transitional care facility:a. Tolerating PO diet, tube feeds or TPN.b. Bowel activity without significant diarrhea or constipation.c. Electrolytes within 5% of “low normal threshold,” replacement underway.d. Hematocrit >22%; WBC not increasing.e. Care is within the scope of the receiving facility.f. IV access good without phlebitis.g. Wounds healing.h. Antibiotic course, if needed, is well established.i. Family or patient understands goal of treatment plan.