Reviewing the discharge of care protocol

In this article, we will review the Discharge of Care protocol. We will cover everything from its purpose to how to discharge the patient in the Rula provider portal and more. 

Purpose

The purpose of this protocol is twofold:

1. to provide a seamless transition and follow-up care for patients of Rula Psychiatric Services and
2. to provide guidance on documentation, discharge letters, clinic support services, and patient communication for those who are deemed inappropriate for our services.

Related links

• Policy: Patient Discharge
• Discharge/Withdrawal of Care Letter
• Kaiser Permanente SBC Discharge/Withdrawl of Care Letter
   

Protocol process

Step One: Discussion of Discharge Plan

• Patients should be made aware of any plans for discharge/withdrawal of care by their psychiatric provider
  • Be sure to document any discussion of termination of care within patient’s chart
• If a referral to a HLOC, such as Intensive Outpatient Program (IOP) or Partial Hospitalization Program (PHP), is part of the discharge plan, please ensure step four is completed

Step two: Documentation - Discharge from Care completed

• Complete Discharge Note in the Rula provider portal
  • There will be a section titled “Patient-facing reason for discharge.” What you write here will appear on the discharge letter to the patient

Step Three: Send the patient the discharge letter

• Rula Communication, instructions, and next steps will be provided to the patient through the Discharge from Care letter
  • Send a message to the VA distribution list asking them to send the discharge letter to the patient
  • The VA will then send the discharge letter to the patient, which includes a resource list/guide
    • NOTE: If in-person services are being requested, the discharge letter includes a guide that contains information to help the patient locate in-person care within their state and no further action is required
  • Communications regarding the discharge letter sent via email to the patient should be marked as "personal/confidential" in the subject line
  • Any inbound clarification or patient communication will be managed by RNs

(OPTIONAL) Step Four: Refer to HLOC

• If you are referring a patient to IOP or PHP as part of your discharge plan please ensure steps 1-3 are completed before proceeding
  • NOTE: This step does not need to be completed if only in-person services are part of the discharge plan.
• Submit a HLOC request using the Provider Referral Form
  • Be sure to include a detailed clinical rationale on why the patient is being referred to this level of care
    • Consider the following:
      • If the patient is currently linked to a therapist:
        • Why can't their needs be met at this level of care?
        • Is the patient aware that they will likely need to stop seeing their therapist for the duration of the IOP/PHP?
      • Some IOP/PHP programs do not provide medication management services and a patient may need to establish care with a new prescriber.
      • In-person IOP/ PHP can be difficult to locate, if so can the patient be seen in a telehealth program?

Updated August 20, 2025 16:35