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Discharge Management: How to Stop Patient Leakage and Readmissions

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HybridChart has solved Discharge Management.

There is a dangerous moment in American healthcare. It isn’t during surgery, and it isn’t during the ER admission. It is the moment a patient is discharged from the hospital to go home.

We call this the “Discharge Gap.”

Traditionally, when a doctor discharges a patient, the data stays in the hospital. The patient goes home, often confused about their medications or follow-up needs. The onus is entirely on the sick patient to call their doctor’s office, wait on hold, and try to explain what happened.

This broken process is where mistakes happen. It is where patients get lost to follow-up (patient leakage), and it is where hospital readmissions occur.

At HybridChart, we believe discharge management is the most important factor for improving patient care—and we have automated the solution.

The Problem: The “Wild West” of Outpatient Care

Inside your office, you have structure: a schedule, staff, and an EHR. Inside the hospital, there is structure. But the space between them? That is the Wild West.

In a standard workflow without HybridChart, your office staff has no idea a patient has been discharged until that patient calls them.

  • The Staff: They are constantly reactive, scrambling to squeeze patients into the schedule at the last minute.

  • The Patient: They are anxious, often waiting on hold for 45 minutes just to get an appointment.

  • The Result: High readmission rates and lost revenue.

As Dr. Greg Sanders explains:

“The onus falls upon the patient to be discharged… simply assuming everything goes well. Remember, these patients may not call, or they may wait on hold and hang up. That’s where patients get lost in the shuffle.”

The Solution: Flipping the Script to “Proactive” Care

HybridChart completely flips this dynamic. We turn your practice from reactive to proactive.

Here is how the HybridChart workflow closes the gap:

  1. Point of Care: The doctor taps “Discharge” on their phone while still at the hospital (taking less than 3 seconds).

  2. Instant Notification: They select follow-up needs (e.g., “See in 1 week,” “Order Echo,” “High Risk”).

  3. Proactive Outreach: The office staff instantly receives this data. They call the patient before the patient even gets home.

Now, instead of a confused patient calling the office, the patient receives a call: “Hi Mrs. Jones, we see you were just discharged. We have your appointment set for Tuesday, and we’ve already ordered your labs.”

The “Game Changer” for Readmissions and Revenue

Effectively managing discharges is not just about being nice; it is about survival in a Value-Based Care (VBC) world.

Hospital systems spend millions hiring nurses to manually comb through charts to find high-risk patients. HybridChart identifies them in real-time. By ensuring high-risk patients (like those with Heart Failure or Pneumonia) get timely follow-up, you drastically reduce the chance of them bouncing back into the hospital.

“When you add in discharge management, it opens the door for quality care improvements… changing the process from just putting in charges to actually improving healthcare in America.”

Furthermore, this stops Patient Leakage. Every patient who doesn’t call back is lost revenue—lost office visits, lost testing, and lost ancillary services.

Conclusion: Bridging the Gap

Connectivity is key. HybridChart doesn’t just capture the discharge; we connect that data back to your EHR and your billing team.

We bridge the gap between the inpatient and outpatient worlds so that your patients—and your revenue—stop falling through the cracks. It’s better for the doctor, easier for the staff, and lifesaving for the patient.

Don’t let your patients get lost in the shuffle.

Schedule a Demo today to see HybridChart greatly reduces hospital readmissions with our Discharge Management solution.


FAQs

Q: What is the “Discharge Gap” in healthcare?

A: The “Discharge Gap” refers to the disconnect that occurs when a patient leaves the hospital but has not yet seen their primary care or specialist physician. This period is high-risk for medication errors and hospital readmissions because traditional communication between the hospital and the doctor’s office is often fragmented or non-existent.

Q: How does HybridChart reduce hospital readmissions?

A: HybridChart reduces readmissions by enabling a “proactive” discharge workflow. Physicians tag patients as “Discharged” and “High Risk” at the point of care via their mobile device. This instantly notifies the office staff, allowing them to call the patient and schedule follow-up appointments immediately, ensuring the patient receives Transitional Care Management (TCM) rather than getting lost to follow-up.

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