Discharge Dialogue: The Practice of a Hospital Based Discharge Coordinator in Transition Encounters with Patients

For several years, efforts have been made to strengthen collaboration between health professionals with different specializations and to improve patient transition from hospital to home (care). In the Danish health care system, these efforts have concentrated on cancer and heart diseases, whereas less attention has been given to medical patients, who are often elderly and suffer from multiple diseases. This paper addresses the latter issue with a case study of a local initiative to improve transition from hospital to home (care) for medical patients at a Danish hospital, in which a discharge coordinator, employed at the hospital, is supposed to anticipate discharge and serve as mediator between the hospital and the municipal home care system. Drawing on methods from discourse and interaction analysis, the paper studies the practice of the discharge coordinator in two encounters between patients and health professionals on each side of the discharge, i.e. a discharge meeting at the hospital and a follow up meeting at the patient’s home. The paper firstly analyzes how decisions concerning the patient’s future need for health assistance are negotiated and reached at the discharge meeting, including how the health professional’s working location at the hospital appears as relevant for identifying and negotiating the patient’s need. Secondly, it is analyzed how discourse from the discharge meeting is recontextualized and possibly modified in the follow up meeting at the patient’s home, including how the home context provides different resources for identification of patient needs and mutual decision making.