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?

[traumaRUs, MSN, APRN]

I live in a rural area - no cabs, no buses, etc.. I too have driven myself home after dental surgery. I do have adult children and a husband that lives 170 miles away but to ask them to take time off work is inconvenient and I just wouldn't do it. If I need endoscopy (crossed fingers never to need), I will do it w/o sedation.

[Mulan]

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

That question wasn't directed to you.

[maracasbelle]

How about providing return transport home via an ambulance or service - at an additional cost to those patients who have no one to take them home? As medical professionals and service, customer-centric and caring persons, this would be the only solution - ensuring that before they are handed over, that they are fully recovered and able to get themselves out of the transport and into their home.

[maracasbelle]

SORRY - MY COMMENT SHOULD READ:

How about providing return transport home via an ambulance or TAXI service - at an additional cost to those patients who have no one to take them home? As medical professionals and service, customer-centric and caring persons, this would be the only solution - ensuring that before they are handed over, that they are fully recovered and able to get themselves out of the transport and into their home.

[RNsRWe, ASN, RN]

Our policies at my endoscopy center (ASC) make it a non-issue, really.

The patient knows well in advance of the requirement for a driver home. They are reminded the day before. Upon arrival at our facility, the admission nurse will inquire as to who the driver is, where they are, etc. MOST of the time, the driver is either standing there with them when this question is asked, or a name and phone number is provided at that time.

Our facility has people in and out in less than two hours, so it's typically not a problem for our patients.

A taxi home is fine, IF they are accompanied by a responsible adult to get them home. Our anesthesiologists insist on that: a taxi cannot just drop you at the curb and buzz away.

In the last year, I can point to exactly two cases in which a patient lied....they had provided a name and phone number, and upon calling the number it was determined to be a cab company. In both those cases, the patient had already undergone the procedure and therefore we were stuck: we couldn't KEEP them, but we also couldn't safely DISCHARGE them. Anesthesia threw a fit, and in each case, we got the cab driver to sign the discharge form that they WOULD be taking responsibility for that patient. Obviously, no one can know what happened when they drove away, but legally our butts were covered. And yes, healthcare in these situations is about legalities; we weren't really afraid our patients would be in danger, but LEGALLY there was a hook to be caught on.

As for the other suggestions: no one would be willing to pay for a medical transport when they can get a friend/relative/co-worker for free, and that's the HUGE majority of our patient demographic. I realize it's not easy for everyone, but honestly, out of thousands of cases a year, they just manage to do it. Those TWO did not. And if someone does cancel because they have no ride, or WE cancel them for that reason, they FIND a ride and reschedule. No problem.

[RNsRWe, ASN, RN]

I live in a rural area - no cabs, no buses, etc.. I too have driven myself home after dental surgery. I do have adult children and a husband that lives 170 miles away but to ask them to take time off work is inconvenient and I just wouldn't do it. If I need endoscopy (crossed fingers never to need), I will do it w/o sedation.

Ah, but everyone should be screened via colonoscopy after age 50, and earlier with a family history of GI issues. I think there's a scope in your future... :)

[NurseMikki]

I wish we could let patients leave by cab after simple procedures, but the local cab companies won't accept liability and refuse to take patients.

I just feel like our hands are tied as healthcare providers trying to limit risk as well as make sure patients are safe.

[theantichick]

Our policies at my endoscopy center (ASC) make it a non-issue, really.

The patient knows well in advance of the requirement for a driver home. They are reminded the day before. Upon arrival at our facility, the admission nurse will inquire as to who the driver is, where they are, etc. MOST of the time, the driver is either standing there with them when this question is asked, or a name and phone number is provided at that time.

Our facility has people in and out in less than two hours, so it's typically not a problem for our patients.

A taxi home is fine, IF they are accompanied by a responsible adult to get them home. Our anesthesiologists insist on that: a taxi cannot just drop you at the curb and buzz away.

[...]

As for the other suggestions: no one would be willing to pay for a medical transport when they can get a friend/relative/co-worker for free, and that's the HUGE majority of our patient demographic. I realize it's not easy for everyone, but honestly, out of thousands of cases a year, they just manage to do it. Those TWO did not. And if someone does cancel because they have no ride, or WE cancel them for that reason, they FIND a ride and reschedule. No problem.

What a short-sighted and privileged response. It's not a problem because thousands of people manage it all the time. What about the thousands you never see because they simply can't arrange it. I know people who have no family, and it's all well and good to say "get a friend" but how many friends do most people have who can or will take off work to drive a friend to a procedure. I've had several procedures in the last year and my parents drove from their home over an hour away in order to get me a ride each time. My daughter is underage and I'm divorced. If my parents were gone or infirm, I would have had only one option - a taxi. If that wouldn't be sufficient, then I would have to elect not to have the procedure. I believe that in the healthcare profession we need to meet people where they are, and try to find solutions for their health issues, not point to all the people who don't have those obstacles and say "why can't you be like them?" The fact is that lots of people are in situations too varied to name, which put them in a situation where they simply do not have anyone to take responsibility for them after a procedure. Several options have been floated here, and I think some of them (or some combination of them) would work. A hard-and-fast rule of "can't get someone to take care of you, reschedule - or just don't have - the procedure" does not address the patient's needs and situation.

[HollywoodDiva]

At any of the facilities I work for they will not proceed to pre-op patient if they don't have a ride nor someone to take care of them at home. The facility had been sued before for a patient driving home after a procedure and causing an accident. Good rule is they need to have a ride after anesthesia and someone taking care of them afterwards.

[RNsRWe, ASN, RN]

What a short-sighted and privileged response.

And what a judgmental and inaccurate one on your part, just now. I responded to the OP's problem with people who lie that they have a way home after being anesthetized, and then don't. She wanted to know what others did about that. I ANSWERED her.

What about the thousands you never see because they simply can't arrange it. I know people who have no family, and it's all well and good to say "get a friend" but how many friends do most people have who can or will take off work to drive a friend to a procedure.......

You seem to be under the impression that it's my job to see how many other people who have difficulty arranging a ride we can possibly get in the door. I do not work for a hospital, but rather a private facility that specializes in endoscopy procedures, and we are packed with patients daily. I have to manage the safety of those we DO HAVE, not the ones who never schedule with us because of the many and varied difficulties of getting a ride.

I believe that in the healthcare profession we need to meet people where they are, and try to find solutions for their health issues, not point to all the people who don't have those obstacles and say "why can't you be like them?" The fact is that lots of people are in situations too varied to name, which put them in a situation where they simply do not have anyone to take responsibility for them after a procedure. Several options have been floated here, and I think some of them (or some combination of them) would work. A hard-and-fast rule of "can't get someone to take care of you, reschedule - or just don't have - the procedure" does not address the patient's needs and situation.

Again, you're being overly harsh, and I'm not sure why....none of the patients that come to our elective procedures facility HAD to be there. None of them had no other choice, which is what you imply when you go on and on about "needing to meet people where they are". There are two hospitals virtually within walking distance of my facility, and anyone in any dire straights could GO THERE. So yes, our "hard and fast rule" that our anesthesiologists--who put their licenses and expectation of lawsuits on the line--insist on IS reasonable.

Not every healthcare facility, and not every healthcare provider, caters to those who have absolutely zero options. It's insulting that you take the tact that we don't address our patients needs and situation....the reality is, our patients DON'T drive stoned, they DON'T get injured or injure someone else by being discharged while under the influence of drugs. Seems to me we're very MUCH taking into consideration not only THEIR health but the health of others they might accidentally hurt if we just turned them loose.

Many of our patients DO have difficult times getting rides, I know that for a fact. I ALSO know that they prefer the quality of care and the ease of our facility over other endoscopy centers AND the hospitals...so they manage, yes.

Our GI docs, anesthesiologists and nurses work this way in this facility to AVOID the legal nightmare that the OP described. No thanks.

By the way, when YOU eventually HAVE a license to lose, as I see you are still a student, perhaps you will view things differently. I hope, at least, you'd be far less judgmental of those who DO this job.

[RNsRWe, ASN, RN]

At any of the facilities I work for they will not proceed to pre-op patient if they don't have a ride nor someone to take care of them at home. The facility had been sued before for a patient driving home after a procedure and causing an accident. Good rule is they need to have a ride after anesthesia and someone taking care of them afterwards.

Exactly. A hundred times over.

I certainly can't help patients if I've lost my license by discharging someone inappropriately or the facility I work in closed because of the financial loss in a suit.

[RNsRWe, ASN, RN]

I wish we could let patients leave by cab after simple procedures, but the local cab companies won't accept liability and refuse to take patients.

I just feel like our hands are tied as healthcare providers trying to limit risk as well as make sure patients are safe.

Agreed. And honestly I was shocked when the cabdrivers in both instances I described were willing to sign the line and take responsibility.....but, it turned out, these patients were also very regular customers of the cab company and so were "known" to the drivers. Considerations made for them, etc.

In my shoes, right now, I'm keeping the patient I HAVE right now, TODAY, safe, as well as the strangers on the road who might be injured if they drove upon discharge.