Medical discharge and followup care

Address issues related to medical discharge and followup care. Health care personnel (preferably examiners) should address the following issues with patients prior to discharge:
 
Make sure patients’ medical and mental health needs related to the assault have been addressed. Discuss with patients whether they have any other medical and/or mental health concerns related to the assault. If injuries or trauma have not been treated yet, examiners should refer patients to exam facility clinicians (e.g., hospital emergency department staff) for care or provide the appropriate community referrals prior to discharge.
Provide patients with oral and written medical discharge instructions.  Include a summary of the exam (e.g., evidence collected, tests conducted, medication prescribed or provided, information provided, and treatment received), medication doses to be taken, followup appointments needed or scheduled, and referrals. The discharge form could also include contact information and hours of operation for local advocacy programs.
Arrange followup appointments for patients.  Followup may be indicated to document developing or healing injuries and complete resolution of healing. (A jurisdictional policy describing the indications and procedures for followup for documentation purposes should be in place.) Appointments may also be needed to address ongoing medical concerns. If appointments are not scheduled, at least indicate to patients which appointments are needed and if sites are different than the initial exam. Make it clear that patients do not have to disclose the assault to receive followup medical care. Followup appointments may include:[1]
  • For patients with evidence of acute trauma: A short-term followup appointment to reexamine and document the development of visible findings and photograph areas of injury; and an exam 2 to 4 weeks later to document resolution of findings or healing of injuries. 
  • For all patients: Repeat exams for STIs according to facility policy (see C.8. STI Evaluation and Care). 
  • Primary health care providers or other nonacute care providers can provide longer term care as needed (e.g., for HIV testing, STI testing, and administering doses of Hepatitis B vaccine). 
Discuss followup medical contact procedures.  Discuss with patients whether they would like health care providers to provide a followup call and, if so, the best method and time for this contact (maintaining patients’ privacy and safety). The main purposes of such a call are to check on medical status and remind patients about the necessity of followup testing and care. An optimal time for a first medical followup contact is 24 to 48 hours following discharge. Personnel following up with patients should be familiar with the case, confidentiality issues, and potential medical needs.[2]

[1] Bullets drawn partially from the California Medical Protocol for Examination of Sexual Assault and Child Sexual Abuse Victims, 2001, p. 98.
[2] When appropriate, advocates may assist health care personnel in encouraging patients to seek the followup medical care they need. They also may encourage patients to discuss with health care providers their concerns about initial and followup medical care.


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