Q&A: Screening patients

Q: When should my case managers be screening the patients?

A: Case managers must identify patients in need of discharge planning at an early stage of hospitalization to allow time to develop and implement the discharge plan and avoid discharge delays. Therefore, the ideal time for screening patients for discharge planning needs to start before or at the time of admission or shortly after admission.

The CMS CoPs indicate that hospitals will be considered compliant if a patient is screened at least 48 hours prior to discharge and there is no discharge delay due to a delay in completing a discharge planning evaluation. There must be no evidence that a delay in evaluating a patient caused a change in his or her living environment.

Some patients initially identified in the screening process as not needing a discharge plan may have a change in condition while being hospitalized. The hospital then screens to determine if a discharge plan is needed and implements one as appropriate.

Screening, at a minimum, takes place each time rounding occurs. This can mean once every weekday on many hospital units or once per shift in hospitals with more than eight hours of daily coverage. Patients may also be evaluated following a request for a screening from the patient, family member, or healthcare provider due to a change in condition.

For more information, see the Case Management Patient Communication Toolkit.

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