Case Study: Discharge Dilemma: Managing Disagreements
Jack Flynn is a 60-year-old construction worker who had a total knee replacement 2 days ago. At this point, decisions about discharge from the hospital are being made. The surgeon recommends discharge to home with an exercise program provided by an application available on the computer or phone, without any other services until after the 6-week postoperative visit. The occupational therapist (OT) recommends discharge to home with immediate follow up by a home care nurse and OT via home therapy services. The physical therapist recommends discharge with a short stay in a subacute rehabilitation facility. The nurse acknowledges that the patient and family can carry out incision care at home but would prefer one to two visits by a home care nurse to follow up with any questions or potential complications. Mr. Flynn and his family are worried about his ability to negotiate stairs when entering the home and regaining full motion in the knee considering the pain and swelling. Mr. Flynn says he does not like computer technology and prefers face-to-face care.
Discussion Questions
- How can the team engage in shared patient-centered problem solving related to Mr. Flynn’s discharge?
- Provide at least three examples of decision-making strategies to plan for discharge and recovery. Refer to Chapters 13 and 14.
- How can available evidence be used to guide effective team decision making in this case study?
