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?

[llg, PhD, RN]

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

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.

You are fooling yourself. You say there is no problem, that it is a non-issue only because it is not a liability issue for you. It might be a MAJOR problem for your patients. How many people in your community need the procedure but are not scheduling it because they don't have a guaranteed ride home? You don't know. All you see are those people who have solved their problem in a way that satisfies your requirements. Alll the other people -- you are not seeing them -- and therefore you are not considering their needs.

That's the problem! Health care systems are not considering the needs of people who can't arrange for their own rides home. That's a major problem for the patients. It just doesn't seem to bother you, personally. You don't seem to feel any sense of responsibility for making your services available to the general community. That's sad. It's a shame so many facilities and people within the health care system only care about problems that effect them personally -- and don't care about the health of their community.

[RNsRWe, ASN, RN]

You are fooling yourself. You say there is no problem, that it is a non-issue only because it is not a liability issue for you. It might be a MAJOR problem for your patients. How many people in your community need the procedure but are not scheduling it because they don't have a guaranteed ride home? You don't know. All you see are those people who have solved their problem in a way that satisfies your requirements. Alll the other people -- you are not seeing them -- and therefore you are not considering their needs.

That's the problem! Health care systems are not considering the needs of people who can't arrange for their own rides home. That's a major problem for the patients. It just doesn't seem to bother you, personally.

Not fooling myself at all. Did you read my follow-up post? The OP asked how other facilities handled this situation, AND I ANSWERED it. You just don't like the answer, which is that we limit our liability by limiting the patients who have this problem. The hospitals, as well as perhaps other centers, are either more willing to take them in or less inclined to "check". So, there you go with the people who can't get a ride: they just DON'T come HERE. Why do you think that SHOULD bother me....that they go somewhere else? And don't think they don't--news travels in a small community, believe me.

A private facility is not a charity; we do not have to take in every single patient who ever wanted these ELECTIVE procedures. We consider very carefully the healthcare of those people who ARE our patients, by making sure they leave safely (see above posts).

Interesting thing is, it's not like all our patients are rich. Far FAR FAR from it. Many are quite poor, and have Medicaid. They don't have a car. So what do they do? They grab a relative who also doesn't drive AND a taxi--which, btw, Medicaid pays for as a 'medical transport'--and here they come.

What would bother me, personally, is if I had to sacrifice someone's physical safety. And with these policies in effect, I don't have to.

It's interesting that no one questions why the MDs won't consider doing procedures/anesthetizing the patients who have no drive home.....and yes they are doing EXACTLY what I'm talking about: limiting liability, so THEY don't lose their shirts/license/medical practice and have their patients lose their doctor's care altogether.

[trufflelilyRN]

Now we are getting to the real problem, which is access to health care for all Americans. Bottom line:MILLIONS of people in America do not have ready access to adequate health care, or ancillary health services. Some communities have ambulance cabs that transport patients home cheaper than an ambulance--used quite a bit for patients such as hip replacement. We, as nurses, cannot solve that problem. Politicians can solve the problem. Google "Physicians for a National Health Care Program."

At this time I live and work in Germany. The Deutsches Rotes Kreuz has different levels of ambulance service, from simple transport to extreme trauma. In serious situations the notaerzt, or emergency physician is dispatched to the scene. All citizens have basic health care from the government. In addition, people can purchase additional health care insurance is desired. Bottom line, again: Everyone has basic access.

We, as individual nurses, and our affiliated organizations, surgery centers, clinics, hospitals etc. have to protect ourselves from litigation (another national problem) or we will be out of work/business. We, as individuals, do not have the resources to do everything for everyone.

Your voices are heard--but not by the people who can change health care in America.

[RNsRWe, ASN, RN]

trufflelilyRN, you hit the nail on the head. Bang.

[Fuzzy]

Here's what happened to me. I was sedated to have three impacted wisdom teeth extracted. My friend was to drive me home a 3:00pm. She had to be at work by 4:00pm. So she dropped me off at noon. The prcedure was to be started at 12:30. It wasn't started until 2:00pm. There in lies the problem. I had no way to get home except for hoofing it. So I didn't "cheat" I was cheated in this situation.

To answer the orginal question. Our patients spend the night for no charge if their ride doesn't show up. After all we just cannot let the cats, birds, ferrets, snakes, rats, and dogs loose. That would be illegal in this area. Not to mention unethical. The second and subsequent nights are charged to the client.

Fuzzy

[theantichick]

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.

You don't have a clue who I am, or what my experience is, beyond the fact I'm a student nurse. You don't know what I've done in my many years in the corporate world, what positions I have or have not worked in in healthcare, what volunteer work I do in my community. I don't have to be a licensed nurse to have experienced the problem being discussed and formed an opinion about how we should be delivering health care in this country.

I understand that the nurses have no option but to follow the procedures outlined by their facility and the orders given by the docs. I believe we should, however, try to identify barriers to health care delivery and try to come up with solutions. I think several really good ideas have been floated in this thread, and I hope that conversation here eventually makes its way to the people who make the decisions, because we're talking about a real issue and floating some do-able solutions.

You said, "it's a non-issue, really" because your center simply doesn't do the procedure if they don't do what they were told, and well they had plenty of notice. There is a large patient population for whom no amount of notice is enough because they simply have no access to the transportation and aftercare that's been specified. You have no clue how many people simply don't have care that they need, because they don't have access. Just because a procedure is "elective" doesn't mean it's not critical to their health care. The fact that your elite facility just doesn't have to deal with that patient population doesn't mean that it's not a problem, or that your facility's response is good for health care as a whole. Hence my observation that ** your statement ** was short-sighted and privileged. I criticized your RESPONSE, not you as a person.

[RNsRWe, ASN, RN]

I don't need "a clue" as to who you are, what you have done outside of being a student. As you don't really need to know my CV either. It's irrelevant to the situation at hand, in which you criticized how I responded to something when it was NOT what I was actually discussing. You criticized my response to a problem YOU perceived as being THE problem. But the OP didn't ask about that at all. I responded to HER question about what to do with some patients in a specific setting--one we seem to share-- not YOUR pondering of how to fix the national crises in healthcare.

I wasn't responding to the problem of "what is wrong with healthcare in this country that patients have trouble getting procedures they want because of the liability issue". I responded to "what do you do if you have patients that 'cheat'" with what WE DO.

You turned it into my apathy for patients on a national basis, who don't have access to healthcare for a multitude of reasons. NOT the OP's problem at all. NOT MY basis of response.

Seems like you needed to debate this perhaps in a different thread? Or, if not, don't attack my position as "short sighted and privileged". It just doesn't relate to what YOU wanted to discuss.

I'm not criticizing you as a person either. By noting that you are a nursing student instead of a practicing nurse, I'm simply pointing out that experience AS a working nurse (regardless of one's previous life experiences) will either give you greater insight OR, at the very least, give greater weight to your position when debating with nurses.

Funny thing is, I don't disagree in the least with what you are saying. I only take issue that you have taken my response out of the context in which it was given, and turned it into something that looks disagreeable. In fact, we DO agree on the national/patient care needs level. However, the OP wanted to know how others would handle this problem---and I told her. Period.

[RNsRWe, ASN, RN]

Here's what happened to me. I was sedated to have three impacted wisdom teeth extracted. My friend was to drive me home a 3:00pm. She had to be at work by 4:00pm. So she dropped me off at noon. The prcedure was to be started at 12:30. It wasn't started until 2:00pm. There in lies the problem. I had no way to get home except for hoofing it. So I didn't "cheat" I was cheated in this situation.

To answer the orginal question. Our patients spend the night for no charge if their ride doesn't show up. After all we just cannot let the cats, birds, ferrets, snakes, rats, and dogs loose. That would be illegal in this area. Not to mention unethical. The second and subsequent nights are charged to the client.

Fuzzy

Your situation sucked, no doubt. The problem, of course, is that your procedure started 1.5 hours late, something that doesn't happen in my world. YES, I KNOW it happens (for those who will point that out) but I'm not sure what we'd do, because it DOESN'T happen that we have a 1.5 hour late start at our ASC. My best guess is since it wasn't that you would have driven yourself home (you didn't have a car there!), but that there was no one to TAKE you home, we might have made a bunch of calls on your behalf to see if there was anyone you knew we could get to come for you. Barring that, I'm a bit stumped. We've had people hang out in our waiting room for an hour or more, waiting for their rides to come for them.

As for your own way of handling the "no shows", lol....yep, I think it'd be a tad bit of a problem if your "patients" made their own way home!

[trufflelilyRN]

RNsRWe, you are spot on. There is a huge difference between the real problem--HEALTH CARE IN AMERICA--and our dilemma as we try to manage the daily fall out. In my setting, the procedure is not started unless the patient has an appropriate way to get home. End of story. I understand this may not work in all settings.

In response to Fuzzy, medicine is a business in America. Not all facilities can afford to keep patients overnight for free. If they can that is great. If a patient at the time of checkout has no option but to "hoof" it home, a taxi would be a preferable alternative.

Another thought. For those of us working in a public system, not all of our patients are the greatest at accepting personal responsibility. We see patients from every social strata. Sometimes they have resources they have not explored, and with our assistance can become more independent in advocating for themselves.

[RNsRWe, ASN, RN]

RNsRWe, you are spot on. There is a huge difference between the real problem--HEALTH CARE IN AMERICA--and our dilemma as we try to manage the daily fall out. In my setting, the procedure is not started unless the patient has an appropriate way to get home. End of story. I understand this may not work in all settings.

Exactly what I was trying to get across.

In response to Fuzzy, medicine is a business in America. Not all facilities can afford to keep patients overnight for free. If they can that is great. If a patient at the time of checkout has no option but to "hoof" it home, a taxi would be a preferable alternative.

well, I think the overnight thing isn't so much a problem in Fuzzy's facility, ans she must work in a veterinary office -- her patient list included four-legged clients, lol! :) Our ASC closes and locks the doors, lights out, there IS no overnight option, period. No humans can stay for any reason whatsoever--we all go home!

Another thought. For those of us working in a public system, not all of our patients are the greatest at accepting personal responsibility. We see patients from every social strata. Sometimes they have resources they have not explored, and with our assistance can become more independent in advocating for themselves.

Bingo again. We often do make calls on the patient's behalf to get them rides, if they look like they're going to be stuck and we won't start without knowing there's a safe way home. It's pretty darned rare, though, as it's known that we won't do the procedure UNLESS there's a plan.

[Fuzzy]

The oral surgeon's office closed at 5:00pm. There was a plan. that plan went bad when the procedure started late. I was new to the area so had no one else to call. I guess I could have called the police and asked for a ride home. Next time I will or I will leave if I have to wait more then 15 minutes. I have learned to do with regular doctor's appointments. I'm older now so I know what is best for me.

Yes, I do work in a veterinary hospital. There are many days that I feel that I treat my patients better then I'm treated in the human medicine system.

Fuzzy

[morte, LPN, LVN]

the bottom line, to me, is that if these patients require this much attention after the fact of the procedure, the procedure should not be done on an outpatient basis. Problem solved.