Appendix A: The First Few Days at Home

GETTING HOME

Patients who survive an episode of critical illness are less commonly discharged directly home. Instead, many more are transferred to another facility for continued but less complex care or for rehabilitation. Discharge from one of those facilities is the immediate step prior to getting home. Of course, travel from such a facility to the patient’s home—or the home of another family member or friend—requires transportation.

TRANSPORTATION

Depending on individual patient needs, sometimes family’s or friend’s private vehicle transportation is fine. For others, especially those who require ongoing care needs at home that depend on devices, specialized transportation is more ideal. In general, ambulance-like transport services are utilized to help with not only travel, but also entry into the home space. Sometimes only a wheelchair is needed, while for others stretcher transport might be required.

EQUIPMENT

If a patient needs specialized equipment such as a hospital bed, a feeding pump, oxygen, or other related care devices, those are delivered the day before the patient is slated to arrive home. This ensures that all necessary care items, including wound care supplies, are in place prior to home transportation. Family members should determine where they would like the equipment to be placed within the home. It is important to assess whether there are electrical outlets for power-requiring devices that are accessible in the location where the devices are to be used. Personal assistive devices such as a cane or a walker are common when muscle mass is lost after prolonged critical illness, and after injury or surgery leading to limb amputation.

MAKING THE TRANSITION HOME SUCCESSFUL

Planning is key for this major transition. It is important to recognize that immediately upon arrival home patients who survive critical illness may not be able to do all of the things they previously did. This is true for those who have developed the post-intensive care syndrome (see chapter on PICS). Therefore, family and friends, but most importantly patients, should adjust their expectations to match their strength, endurance, and cognitive and psychosocial abilities on the day they arrive home. This is often quite frustrating for the patient as the transition home signals “recovery” and they expect that they can simply resume their normal life activities.

Since many require ongoing care, there are a variety of things that patients and caregivers can do to help with that process. These undertakings should start on the first day of arrival home. They include, but are not limited to, the following:

1. Make a folder of all hospital and secondary facility paperwork including discharge summaries; plan to bring them to all first-time healthcare appointments after hospital discharge.

2. Make a list of current medications, when they are to be taken, and the pharmacy that fills those prescriptions.

3. Create a calendar listing of all ...