Patients who "cheat" and drive home

[Lilme04]

I work at an endoscopy center (and a freestanding surgery center). A few times, we've had patients lie to us about how they are getting home, and they've ended up returning to their cars, and driving home. Of course we find this out too late to get a license number. Once, myself and another nurse walked around the hospital across the street to see if we could locate the car, but the patient had already left in it, after giving us vague directions as to where he had parked.

I am responsible for my patients' safety, and ultimately that of the general public, as I mostly work in recovery/PACU.

Any ideas on how we can combat this problem?

[Fuzzy]

I find it interesting that most "solutions" are focusing on minimizing the legal liability of the health care provider -- and no one is trying to find solutions to the patients' problem.

The patient needs health care, but can't get it because they are single, live alone, etc. and their friends have to work for a living -- and can't take off work to drive them. As a profession, we should be talking about ways to help the patients get the care they need (and get home) safely. We should be talking about the kinds of services we should be providing that we are not providing now.

1. Performing procedures in the early eveing and/or on weekends, when friends may be more available to give people rides home.

2. Allowing patients to leave via taxi-cab.

3. Partnering (or establishing) a service that would provide safe rides home for a fee.

4. Scheduling those procedures early in the day so that the patient would have time to adequately recover before driving himself/herself home later in the day.

Any other ideas?

Yes as a single person, I like these suggestions. One I would like to add is the approximate time that the patient can leave. I remember when I had my wisdom teeth extracted, the procedure lasted longer then what my "driver" was told. She had to go to work and I had no other way to get home. I ended up walking 1.5 miles home.

Fuzzy

[plumiegirl]

arrange for a taxi to pick you up and take you back home comes to mind, your life is worth it.

[wannabecnl]

I've wondered about this, as well as how to support patients who have had surgery and/or anesthesia but go home to empty houses. Also, if the patient signs out AMA, does insurance still cover the procedure? Patients would need to be aware of issues like that before signing out AMA.

[jtmarcy12, BSN, RN]

I work at an endoscopy center (and a freestanding surgery center). A few times, we've had patients lie to us about how they are getting home, and they've ended up returning to their cars, and driving home. Of course we find this out too late to get a license number. Once, myself and another nurse walked around the hospital across the street to see if we could locate the car, but the patient had already left in it, after giving us vague directions as to where he had parked.

I am responsible for my patients' safety, and ultimately that of the general public, as I mostly work in recovery/PACU.

Any ideas on how we can combat this problem?

I realize it may be dangerous, but as a Registered Nurse, I too have done this. I drove myself home from having cortisone put into my lower back(I can't think of the name of the procedure). I had no one to take me home. I am not married and have no loverboy. So I had The procedure once before and a friend was living here at the time. She came to pick me up and I "rested" at her place after about 30 mins., I drove home. It it sad that sometimes people just don't want to be bothered in this day and time. I felt fine, and would not have driven if I think I could not have handled it. I think if the patient does this the nurse cannot be held responsible nor the clinic. That was that person choice to do so. I probably will move where I can be near family and I will not have this problem again.

[jtmarcy12, BSN, RN]

I love your suggestion that we should be partnering with a service to provide safe rides home, but again what if something happened on the way home? In this litigious society everyone is on guard, what a shame we just can't offer help without worrying about being sued.

[jtmarcy12, BSN, RN]

Yes exactly. There are many who live alone, such as myself. What then? Does the clinic check on that person to be sure they have food, etc. As the population ages we will have more and more of people trying to drive themselves home from a procedure because, for whatever reason no one is available.

[NurseMikki]

I work in a hospital's same day surgery area and we also recover/discharge endoscopy patients. We have had this instance multiple times and our new practice is to confirm there is a ride PRIOR to the procedure beginning, having the person's ride come inside the hospital and cosign the discharge papers and letting them know that by signing they are agreeing to be the patient's 'responsible' driver home. There have been one or two times a pt was transferred to the floor for an extended period until they were deemed safe to be discharged by the physician.

[brownbook]

I found a good site that covers medicare and accreditation information about this topic, incidentally a lot of interesting topics about all areas of hospitals, out patient surgery, GI clinics, etc.

I am not very computer literate so bear with me, but type in pennsylvania patient safety authority, their web site comes up, a small search box is near the top left side, type in discharge and get a lot of great information.

Off topic but it kind of annoys me that some nurses (as patients) think a doctor or clinic should be obligated to help them with transportation, or be open different hours just for them. Take some responsibility for yourselves!

Also in Europe it is common practice for GI procedures to be done without sedation. If you really need a GI procedure and absolutely cannot get transportation home, tell your doctor you will do it without sedation. I've assisted patients with colonoscopies and EGDs without sedation.

[Denroc72, BSN, MSN, LPN, RN, APN]

The department can either change their holding/discharge procedures and/or have the patient sign a document that they will be transported by "xxxx" person and then have that person present and sign the document at discharge. The idea would be similar to that when mothers are being discharged with their newborns.

[Mulan]

Really, what's wrong with taking a cab (if you can get one).

[BellyDancer66]

I have worked in an endoscopy clinic and for a dental surgeon, and the the person who will be driving the the patient home must come into the clinic so we can give them instructions and so we can verify that the patient will not be driving. If the patient did not make arrangements to have someone else drive them home then the procedure will be cancelled. We never let the patients walk out of the clinic alone.

Ottawa, Canada

[Fuzzy]

Really, what's wrong with taking a cab (if you can get one).

Some areas do not have cab or any other public transportation. For this reason I had no choice but to walk 1.5 miles after oral surgery. My friend who was to take me home had to go to work at a certain time. Of course since I'm a proponent of Murphy's Law, theprocedure was started two hours later then scheduled.

Fuzzy