Page 6 - HPB Handbook - May 30 2022 (Flipbook) v2

Page 6 of 22

UNIT POLICIES

Staff Cover
One staff will cover all inpatients and consults (including all transfers from external hospitals) on a weekly basis. Sign-over
rounds will take place at 08:30 every Friday morning unless otherwise arranged. (07:30 during the summer months). All staff
queries regarding inpatients should be directed to the HPB staff on-call. It is up to the staff on-call to involve the other
staff surgeons as required; this is not the resident’s responsibility.

Referring MDs
Where a patient has been referred from another hospital, or by another surgeon, it is important to keep the referring doctor
informed about the progress of that patient. In this situation it is not just a matter of sending a copy of the discharge summary
– it is the role of the senior resident to telephone the referring doctor or delegate responsibility of this to the junior staff at
appropriate intervals to keep him/her appraised of the latest developments.

Discharge Protocols

Notification of Discharge Policy
Communication to primary care-givers is essential if we are to provide a high standard of care to our patients. The electronic
discharge summary is to be completed by the junior resident or PA (Krista) prior to discharge so that the patient carries a printed
copy out of the hospital on the day that they leave our care. This facilitates rapid essential communication with the family
doctor or other medical professional as required. This discharge summary does not negate the need to call family doctors when
required in situations where direct doctor to doctor communication is essential. Please check the summaries for accuracy as
patient do read them. If you don't know, ask! And keep the information provided succinct and clear.

Collaborative Discharge
Patients should be instructed to call the attending surgeon’s Administrative Assistant for a postoperative appointment
approximately 4-6 weeks after discharge unless otherwise requested (such as a clinical trial). It is the resident’s responsibility
to ensure that pertinent and urgent instructions are passed on to the family doctor prior to the patient’s discharge (i.e., new
medication, inpatient complications, removal of sutures, etc.). Also, be sure to include instructions for drain care, i.e. timing
of removal and imaging required prior to removal, so that Administrative Assistants have some direction in arranging and
facilitating this imaging. Dictated summaries from the staff surgeon are often delivered to the family doctor many weeks after
discharge and therefore it is essential that electronic discharge summaries are filled in on time for discharge day.

It is also the responsibility of the resident staff to ensure that patients are ready to be discharged by 11:00 on the day of
discharge. This includes ensuring patients are safely mobile, ensuring patients relatives are adequately informed of the
discharge plan, ensuring other medical health services are involved if necessary (home care, physio, OT, etc.).
Collaborative Discharge Planning on 9ES
Discharge planning should be included in the discussion at the morning rounds. Social worker, Physiotherapy, Occupational
therapy, and CCAC have to assess patient for eligibility to rehab, CCC or a Long Term Care Facility once it is determined
that patient is medically stable for discharge from acute care.
If patient is going home with support from CCAC…
1) Ensure that CCAC is given 24 hour notice for referrals for home care/support before expected discharge
2) If CCAC application requires input from Allied Health, ensure patient has been assessed first by Allied Health
member, and ask Allied Health member to complete their portion of application before submission (Dietitian, Social
Work, OT/PT, Nursing)

If patient is going to rehab/Complex Continuing Care (CCC)
1) Ensure that PT/OT have been following patient, and have deemed patient appropriate for rehab
2) Ask Social Work to launch rehab application
3) Once application is launched, fill out appropriate portions of rehab application before submission within 24 hours
(Nursing, OT/PT, Medical, Social Work)

**For CCC only: Social Work to discuss CCC co-payment with patient and family
If patient is going to palliative care…
1) Medical team initiates palliative care referral after a discussion with patient/family.