What are the discharge arrangements for a 77-year-old female patient with pneumonia who has met physical therapy (PT) and occupational therapy (OT) goals but lacks transportation upon hospital discharge?

From the Guidelines

For a 77-year-old female being discharged after pneumonia treatment without transportation, I recommend arranging medical transportation services through the hospital's discharge planning team. The social worker should be consulted immediately to coordinate appropriate transportation options, which may include non-emergency medical transport, hospital-provided shuttle service, or arranging a ride through community senior services 1. Medicare may cover transportation costs if medical necessity is documented. Additionally, ensure the patient has all discharge medications, written instructions for home care, and scheduled follow-up appointments before leaving. Consider arranging home health services for initial post-discharge support, particularly for medication management and monitoring recovery.

Key Considerations

• The patient's lack of transportation is a significant barrier to recovery, and addressing this issue is crucial to prevent readmission and ensure continuity of care 1.
• Individualized discharge planning is essential in the transition from hospital to home, and alternative methods of communication and support, such as telephone visits or telehealth, may be considered, particularly for patients in rural settings 1.
• The discharge coordinator should also verify the patient's home environment is safe for her return, with necessary support systems in place for her continued recovery from pneumonia.

Discharge Planning

• The hospital's discharge planning team should work closely with the patient, her family, and healthcare providers to ensure a smooth transition to home.
• The team should assess the patient's social needs, including transportation, and develop a plan to address these needs, which may include referrals to community resources or social services 1.
• The patient's medication regimen should be reviewed, and arrangements made for her to receive necessary medications and equipment at home.
• Follow-up appointments should be scheduled, and the patient should be educated on her condition, treatment, and any necessary self-care activities.

From the Research

Discharge Arrangements for a 77-year-old Female Patient with Pneumonia

• The patient has met physical therapy (PT) and occupational therapy (OT) goals but lacks transportation upon hospital discharge.
• There is no direct evidence in the provided studies to address the discharge arrangements for this specific patient.
• However, a study on transportation barriers to care among frequent health care users during the COVID pandemic 2 found that approximately 1 in 3 respondents experienced transportation barriers to health care, and individuals aged 18-64, people with disabilities, and people without a household vehicle were significantly more likely to encounter transportation barriers.
• The study recommends more coordination between transportation and health professionals and the implementation of programs that expand access to and improve patient awareness of health care mobility services 2.
• Another study on the utilization of broad- versus narrow-spectrum antibiotics for the treatment of outpatient community-acquired pneumonia among adults in the United States 3 does not provide relevant information on discharge arrangements.
• Studies on intrafacility transport of adult intensive care patients 4 and interfacility transport of high-acuity patients with severe acute respiratory syndrome coronavirus 2 infection 5 focus on transport within or between facilities, rather than discharge arrangements.
• A study on the use of a multiplex PCR pneumonia panel in critically ill patients 6 found no association between the panel and mortality, antimicrobial therapy duration, or hospital and ICU stays, but does not address discharge arrangements.