After all this time...

[RiverNurse]

... needing a little confidence boost after two years at this...

Had a patient that was discharged before I came on shift. I took report and was told that the patient was waiting for her ride. After report, I did my assessments, and spoke with the patient. Evidently the patient's only family was out of town and the patient did not have a key to her house.

After some discussion, the house supervisor was called and she determined that the patient could stay overnight - it was 9 pm by this time. I documented all the above in the progress notes in the patient's chart. The next morning I was told I should have informed the doctor and was not given a reason.

I figured that the patient was safe - there was nothing the doctor needed to address and I'd documented it in the chart and that the doctor would see it when he arrived.

Obvious question is: Why should I have called the doctor?

Thanks,

RiverNurse

[caliotter3]

I just see it as a general precaution for the doctor to know what is going on with his patients. The presence of the patient in the hospital could have posed problems had she had medical problems post discharge. The doctor would not want to be caught up short if there was some kind of circumstance where he was questioned and did not even know that his patient had not made out of the hospital. Liability issues?

[dansamy]

You should have notified the a/s. The MD discharged the patient. He/she would have reported off to the on-call MD for the group that this pt was d/c'ed. Also, the pt would not be seen during rounds without the MD being notified because the MD d/c'ed the patient and wouldn't have expected/anticipated that the pt remained in the hospital. Being that it was only 9pm and the on-call MD was most likely not sound asleep, a courtesy notification should have been made.

[Tait, MSN, RN]

If I am having a hard time discharging a patient I call and get an order from the MD to keep the patient overnight. Rationale? Cost, insurance and reimbursement. There is a chance that if the patients insurance caught wind that there wasn't an order for the patient to stay overnight that they might find it an easy way to decline paying. Costing the hospital and possibly the patient a lot of money and grief.

Chock it up to learning :)

Tait

[MedSurgeMess]

If I am having a hard time discharging a patient I call and get an order from the MD to keep the patient overnight. Rationale? Cost, insurance and reimbursement. There is a chance that if the patients insurance caught wind that there wasn't an order for the patient to stay overnight that they might find it an easy way to decline paying. Costing the hospital and possibly the patient a lot of money and grief.

Chock it up to learning :)

Tait

Exactly, especially if anything happens