Can nurses discharge patients

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The transition from inpatient hospital care to more extensive medical, rehabilitative or nursing care represents a particularly critical phase in the treatment and supply chain for the patients concerned. In order to avoid gaps in care due to inadequate or uncoordinated follow-up treatment, hospitals according to Section 39 Paragraph 1a of the fifth book of the Social Security Code (SGB V) is obliged to ensure effective discharge management to support the transition to follow-up care.

The discharge management was comprehensively reformed with the Statutory Health Insurance Supply Strengthening Act (GKV-VSG 2015). On the one hand, the previously limited options for hospitals to initiate follow-up treatment and prescribe services have been expanded. Responsible hospital doctors can now prescribe medication, bandages, remedies and aids, home nursing and sociotherapy for a transitional period of up to seven days, as well as certifying incapacity for work. On the other hand, the National Association of Statutory Health Insurance Funds as the central association of the Federation of Health Insurance Funds and the Central Association of the Federation of Care Funds, the National Association of Statutory Health Insurance Physicians and the German Hospital Association e.V. were legally mandated to conclude a binding framework agreement on discharge management and to specify the requirements in detail.

The framework contract for discharge management became binding for hospitals on October 1, 2017. According to this, in order to guarantee a seamless transition for patients to the subsequent care areas, hospitals have to use a suitable assessment to record the individual patient needs for follow-up care as early as possible and to draw up a discharge plan. Differentiated assessments and specific standards must be provided for groups of people with complex care needs (e.g. for patients with limited mobility and self-care). When drawing up the discharge plan, the necessity of follow-up medication, ongoing incapacity to work and other services that can be prescribed or initiated (e.g. SAPV, short-term care, domestic help) are checked at the same time. As soon as the need for support from the health or long-term care insurance fund is determined, the hospital will contact you in good time, especially if there is a need for care in the areas of care (e.g. when applying to determine the need for care and to include care counseling according to Section 7a of Book XI of the Social Code) Nursing care (including out-of-hospital intensive care) and domestic help, rehabilitation, supply of aids, home care as well as services that require approval and as part of transitional care (short-term care). The hospital, together with the health and long-term care insurance, must organize the necessary care for the implementation of the discharge plan in good time before discharge, e.g. contact the necessary service providers (e.g. contract doctors, rehabilitation facilities, outpatient care services, inpatient care facilities) and for to ensure their timely use. The German Hospital Society e. V. has published further implementation instructions for hospitals on the requirements of discharge management (www.dkgev.de), in which in particular the minimum content of the discharge plan is recorded.

The hospitals provide information on discharge management on their respective websites.

Discharge management and the necessary data transfer to further care providers and facilities require the patient's written consent. The right of the patient to freely choose a doctor and the right to choose the benefits of long-term care insurance or the benefits for participation must also be preserved within the framework of discharge management.