Patients who "cheat" and drive home

  1. 0 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?
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  3. Visit  Lilme04 profile page

    About Lilme04

    Lilme04 has '3 months and counting :)' year(s) of experience and specializes in 'PACU'. From 'Northern CA'; Joined May '04; Posts: 81; Likes: 8.

    62 Comments so far...

  4. Visit  Jory profile page
    6
    You cannot legally hold a patient prisoner. If they want to sign out and leave, they ultimately can. If they get in a car and drive, that is their choice and the hospital has no control over it unless they are ordered to stay by a court order.

    You can call the police, but if the police pull them over and in fact, they are not impaired (depending on how much anesthesia they still have in them), then the hospital can get sued.

    If you have discharged the patient and they leave, then that is the end of it. You have no control over someone lying to you.
    redhead_NURSE98!, NurseSDP, noyesno, and 3 others like this.
  5. Visit  Ashley, PICU RN profile page
    0
    I agree that the best you can do is provide education regarding the reasons why the patient needs transport home- the effects of anesthesia, impaired reaction time, etc. But after that, once the patient is out the door, they get to make their own decisions.

    Just like on a post-partum floor, the nurses can make sure that the parents have a proper car seat and know how to strap the child in, but once they are discharged the nurses cannot force the parents to correctly use the car seat every day.

    Patients will make their own decisions, often regardless of medical advice. You are responsible for educating your patients. THEY are responsible for their own safety/actions once they leave your facility.
  6. Visit  morte profile page
    0
    BUUUT, what happens when they are not able to make wise choices? and you don't stop them, and they kill some one. You really think the family of the deceased isn't going to sue?
  7. Visit  llg profile page
    6
    What is a single person supposed to do? I face this issue from the opposite side of the fence sometimes. You have to schedule procedures/exams during the work week -- yet all my friends work for a living and can't give me rides. Some practices aroung here won't discharge you if you say you are taking a cab home. They require a friend or relative to take vacation time off work to come to the office to pick you up. I am facing that issue now while trying to schedule an eye exam!

    Medical practices have no plans for dealing with the needs of single people. For example, their procedures could be scheduled early in the day so that they could wait several hours before driving home. They could accept a taxi cab as a "ride home." But most give no reasonble options to the patient -- except to lie to them.
  8. Visit  pacurn75 profile page
    1
    This is really getting to be a problem for all specialties that do same day procedures. I work in both PACU and GI. At a recent conference, we talked about it and boy, what a discussion. Some things to consider: If you call the police and say they are impaired, you may risk a HIPAA violation. Signing out AMA it probably the most rational thing to do as regards your practice. Some facilities are even refusing to send patients home with their driver if the driver appears impaired. The one reader is correct, you cannot stop them as it would be construed as false imprisonment.

    At our facility, we have just gotten very particular about confirming a driver and our physicians are refusing to do the case if there is no confirmed driver that we can contact. We will do our best to call the patient's church, groups, or friends to see if they can help, but we do not sedate if they don't have a driver. If they say they have someone coming, we even call them before we start to confirm. Unfortunately, there have been too many cases to count where the supposed driver knew nothing about needing to come.
    redhead_NURSE98! likes this.
  9. Visit  coneil profile page
    5
    I have this same problem from a patient point of view. I haven't scheduled an endoscopy procedure for over 1 year because I have no one to drive me home. What are people supposed to do in this case?
  10. Visit  mcmgal profile page
    1
    Quote from 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?
    I believe if you have a patient who signs a form preoperatively that they are aware they must have someone to drive them home post procedure and you have documented their cognitive status upon discharge, you should not worry. You can check with an attorney if you want to get a legal opinion.
    maelstrom143 likes this.
  11. Visit  saltwaterstat profile page
    0
    why not make it mandatory that they are discharged, via wheelchair to car. put this notice in the pre-op package. if this fails (once you get outside & then find "no driver"), have them sign an AMA. It should, at the least, reduce the # of times this happens.
  12. Visit  trufflelilyRN profile page
    0
    I work at a military facility. Upon arrival the patient must be accompanied by the person who will drive them home or the procedure is cancelled. At the very least, if the procedure is lengthy they must provide the specific contact information for that person and the time they will arrive.
  13. Visit  llg profile page
    4
    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?
    OutlawMedic, jtmarcy12, Fuzzy, and 1 other like this.
  14. Visit  nrsintrning profile page
    1
    Quote from llg
    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.
    That's the spirit of health care right there. It's sad that the perspective we take is always about how to protect ourselves and our money, but that's what the industry - and America in general - has created...
    jtmarcy12 likes this.
  15. Visit  Fuzzy profile page
    2
    Quote from llg
    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
    llg and jtmarcy12 like this.


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