A lawsuit recently levied against a hospital accused of discharging a homeless patient to city streets serves as a reminder that physicians need to look beyond a patient’s immediate health concerns when considering care transitions, one hospitalist says.

As reported in the Los Angeles Times, Glendale Adventist Medical Center in Glendale, Calif., has agreed to pay $700,000 in civil penalties to settle a lawsuit brought against it by the Los Angeles City Attorney. A hospital spokesperson said the medical center denies the charges but has agreed to pay the fine to avoid the cost of fighting the allegations.

“We have to be able to recognize that just writing a discharge order is not meeting any of our patients’ needs,” says Gregory Misky, MD, hospitalist and associate professor of medicine at the University of Colorado (UC) Hospital in Denver. “It’s hard to expect we can fix their COPD or manage their diabetes when there are all these layers of social and behavioral health needs.”

Dr. Misky says he gradually became interested in issues affecting indigent patients while researching ways to help patients transition from hospital to home.

“Some patients are dealing with financial issues,” he says. “Some have acute family crises they’re dealing with. Some have homelessness issues or housing issues. All those things interfere with their health and ability to prioritize health needs over these other things.”

One of Dr. Misky’s current research projects involves performing qualitative interviews with patients who are readmitted within 30 days to learn what challenges they dealt with after being discharged.

As for “patient dumping,” Dr. Misky says that, in his experience, hospitals typically do the opposite: hospitalize patients for indefinite periods of time when they seem to have no family to turn to, for example, or are dealing with cognitive issues.

Here are Dr. Misky’s tips for providing better discharges:

• Be aware: Not all patients are equal. It’s important to realize patients may not recuperate from pneumonia if they are living on the street;
• Rely on case managers: Hospitalists at the UC Hospital perform discharge rounds with a team that includes a case manager, who is usually a registered nurse or social worker. Let the case manager know about your patients’ needs; and
• Form partnerships: Learn about how you can match up your patients with resources for homeless people available in your community.