Rasmusen identified factors which could be used to identify patients who are likely to need discharge planning. Discharge planning may need to be started early in patients with complex or difficult conditions.
NOTE: The screening tool was developed in 1984. Since then a significant amount of medical care has shifted to ambulatory services and inpatients are discharged more quickly. This means that discharge planning may need to be considered prior to admission to a facility.
High risk factors for identifying patients who may need discharge planning:
(1) unable to manage self-care (activities of daily living, ADL) safely on their own
(2) comatose or semi-comatose
(3) disoriented, confused, forgetful
(4) unable to perform wound care properly (complicated dressing; unable to reach site; unlikely to perform without supervision)
(5) requires equipment and/or transportation
(6) unable to follow medication schedule (injections; complex schedule; non-compliance)
(7) presence of ostomy (colonoscopy, ileostomy, etc.)
(8) social problems (living alone or living with someone unable to assist; homeless; dwelling inadequate under current circumstances; insufficient economic resources)
(9) presence of a disease with special teaching needs (diabetes, renal failure, etc.)
(10) terminal or pre-terminal illness
(11) requirement for rehabilitative therapy (occupational, physical, other)
(12) presence of indwelling tube (foley catheter, gastostomy, supra-pubic, nasogastric, tracheostomy)
(13) need for transfer to another facility
Medical diagnoses most commonly needing discharge planning:
(1) arthritis
(2) cancer
(3) cerebrovascular accident
(4) chronic renal failure
(5) congestive heart failure
(6) diabetes mellitus
(7) emphysema
(8) hypertension
(9) myocardial infarction
(10) respirator-dependent patients
