There is a lot you can do to support the general practitioner’s care of your patient after discharge home.
Imagine you are Joe’s general practitioner. Joe has a terminal illness and the last time you saw him was when he had difficult symptoms and you sent him to hospital. Six weeks later Joe’s wife calls you and says that Joe came home yesterday and now feels terrible. What should they do? You ……
- don't have a discharge summary
- have no idea what happened during Joe's hospital admission
- don't see many people with end of life illness
- have an overflowing waiting room.
How to support the general practitioner
Support the general practitioner and promote successful discharge home by:
- calling them to discuss complexities and changes
- informing them of any referrals, for example, to community palliative care
- giving them a name and phone number of an appropriate person in the treating team
- recommending HealthPathways, an online portal designed for general practitioners. The site holds local and relevant information about medical conditions, symptom outlines and management options, and information about how to refer to the most appropriate local services.
- advising them of End of Life Directions for Aged Care (ELDAC) - 1800 870 155 if the patient is going to a residential aged care facility
- expediting the discharge summary
- communicating relevant information from the acute resuscitation plan to inform advance care planning.
In the meantime, send the general practitioner:
- results of the most recent investigations
- summary of family meetings
- palliative care intentions and expected outcomes
- medical power of attorney
- coronial status.
Refer to Therapeutic Guidelines Palliative Care 2016 Version 4
on the Clinicians Health Channel at your health service