'Not safe for discharge'? Words, values, and person-centred care

Area of Science:

• Geriatrics
• Healthcare Policy
• Patient Safety

Background:

• The term 'not safe for discharge home' is frequently applied to elderly patients in hospitals, often due to functional deficits or fall risks.
• The criteria for determining 'safety' for home discharge and the responsible parties remain undefined.
• Labeling patients as 'unsafe' carries substantial practical and ethical consequences.

Purpose of the Study:

• To explore the complexities surrounding the determination of 'safety' for home discharge in older adults.
• To advocate for a revised approach to discharge planning that prioritizes patient values and shared decision-making.
• To improve the quality of care and discharge processes for elderly patients.

Main Methods:

• This commentary reviews the implications of current discharge terminology.
• It proposes a shift from binary 'safe/unsafe' labels to identifying and addressing specific safety concerns.
• It emphasizes the importance of integrating patient values and preferences into the discharge decision.

Main Results:

• Current practices of labeling patients 'unsafe' lack clear standards and have significant ethical implications.
• A holistic approach identifying specific safety concerns is more effective than a simple safe/unsafe dichotomy.
• Incorporating patient values enhances the discharge planning process.

Conclusions:

• Discharge planning for older adults requires a move away from simplistic 'safe' or 'unsafe' labels.
• A person-centered approach involving shared decision-making and addressing specific safety concerns is crucial.
• Refining communication and considering patient values can significantly improve discharge outcomes and care quality.