Discharging by Wheelchair

  1. I've always been perplexed by the practice of discharging a patient, who will be independently ambulatory upon discharge, by routinely taking them to the hospital exit in a wheelchair. In my experience this opens up the hospital to significant liability issues, is there a rationale that justifies this that I'm not seeing?
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  2. 65 Comments

  3. by   Susie2310
    In my experience it seems that the assumption is often made that the patient will be ambulating independently at home on discharge, possibly with some assistance or PT at first, but in reality they may have only recently began to ambulate in the hospital and are not yet really physically able to safely walk the distance (which can be considerable) from their hospital room to the hospital exit door and to the vehicle of their awaiting ride home. So it is a liability precaution/safety measure employed by the facility to ensure that the patient reaches the vehicle of their ride home without falling on facility property.
  4. by   MunoRN
    Quote from Susie2310
    In my experience it seems that the assumption is often made that the patient will be ambulating independently at home on discharge, possibly with some assistance or PT at first, but in reality they may have only recently began to ambulate in the hospital and are not yet really physically able to safely walk the distance (which can be considerable) from their hospital room to the hospital exit door and to the vehicle of their awaiting ride home. So it is a liability precaution/safety measure employed by the facility to ensure that the patient reaches the vehicle of their ride home without falling on facility property.
    So if you feel they aren't able to safely ambulate independently at the time of discharge, why do we assume that something magical will happen in the 5 or 10 minute car ride home that will suddenly make them safe to independently ambulate?
  5. by   MunoRN
    I ask this because part of my FTE is as a sort of liaison between our risk management and clinical practice. We had a case where a patient was suing for unsafe discharge after falling at home after discharge, all they have to prove is that hospital staff was aware they weren't safe to ambulate independently, and the fact that the nurse charted that they were discharged via wheelchair (because the nurse didn't think it was safe for them to ambulate to the hospital exit) made it a slam dunk for them.

    It wasn't hard for them to find similar cases, mainly involving "ambulatory" surgery centers, in each case the plaintiff won easily, so I'm not sure why the practice persists.
  6. by   Susie2310
    If the patient was ambulating safely on the unit i.e. walking around independently up and down the corridors prior to discharge, and was discharged in the care of a responsible adult who would assist their walking at home if needed/assist their needs at home, with the offer of physical therapy and home services if needed, discharging the patient in a wheelchair so that they aren't expected to walk the often considerable distance from their room in the facility to the vehicle of their awaiting ride home in the facility parking lot is reasonable to me. It means they get to the vehicle of their ride home safely, which is to their benefit and the facility's.
  7. by   Susie2310
    Quote from MunoRN
    I ask this because part of my FTE is as a sort of liaison between our risk management and clinical practice. We had a case where a patient was suing for unsafe discharge after falling at home after discharge, all they have to prove is that hospital staff was aware they weren't safe to ambulate independently, and the fact that the nurse charted that they were discharged via wheelchair (because the nurse didn't think it was safe for them to ambulate to the hospital exit) made it a slam dunk for them.

    It wasn't hard for them to find similar cases, mainly involving "ambulatory" surgery centers, in each case the plaintiff won easily, so I'm not sure why the practice persists.
    I understand what you are saying.
  8. by   Susie2310
    The situation appears to me to be more a question of appropriate discharge planning.
  9. by   klone
    I got thoroughly chastised recently because I let a mother walk out of the hospital, CARRYING her newborn in her arms (she had a convertible carseat in the car).
  10. by   caliotter3
    Quote from Susie2310
    . . . . So it is a liability precaution/safety measure employed by the facility to ensure that the patient reaches the vehicle of their ride home without falling on facility property.
    This is what I have been told.
  11. by   Tenebrae
    I think it is an ingrained habit of sorts. in my local hospital, due to earthquake damage repair there is currently only one entrance and exit, and if someone is discharging from the medical wards it can be a hell of a long walk for a newly discharged patient.

    I think though it requires some critical thinking, for example, my mum is terminal and I suspect in the last stages of life. She was in hospital recently for urosepsis, and while she is able to walk short distances around the ward she would have most likely collapsed had she walked all the way from the ward to the exit. . A young healthy or even an older healthy patient may perfer to walk out, some like to walk but have a wheelchair to carry their suitcase

    I think the crux iMO is dont just do something without thinking, we need to be asking ourselves 'if this patient is mobile, why do they need a wheelchair" or do they just need a chair for their stuff
  12. by   KatieMI
    On the one hand, definition of what is considered to be "able to ambulate" can be different between hospital and real life outside it. If patient "ambulates safely" within his room or even within unit, it doesn't authomatically mean that he would be able to do the same in his own house, or to walk those endless corridors. As a facility is responsible for a patient's well-being up to the last second of him/her being within it, it seems logical to ensure "safety" by, for example, not making patient ambulating and providing wheelchair even if he can perfectly walk on his own.

    Secondly, I've noticed that the wheelchair seems to be included in what I name "entitlement package". There is a group of patients who really think that being pushed around in wheelchair, wiped after using toilet, given more of "good meds", calling for assistance for every trivial reason, etc. is somehow included into their hospital stay program. At least, that's how they describe "good care" if someone bothers enough to take time and speak with them. The very same people request home health care RN to come every morning to wipe them or provide them with wheelchairs during their outpatient visits although everybody just saw them jumping cheerfully out of their trucks. These "clients" are commonly "frequent fliers" as well, and they can be given what they demand just to keep things calm. After a while, some genius up there in Ivory Tower of Administration might start thinking that "customers" for some reason enjoy wheelchairs and "implement a policy of improvement" of this part of "our most wonderful customer service", thus mandating their use in all circumstances.

    And, last but not least, something tells me that even in absence of such policy there still be that most impenetrable argument of "we ALWAYS do it this way here". Ingrained habit plus rationalization, one of the worst combinations to fight in human psyche

    In this context, I find it interesting that patients who sign out AMA seem to be not authomatically "offered" wheelchair and expected to walk out of there on their own. I'd seen nurses and aides getting very grudging about pushing out a patient who signed AMA paperwork but was clearly not fully ambulatory and needed help to get into private car with family waiting in it on "drop in/off" spot. Also, several times when I was in ER I was told that I had to stay in my room and that walking 50 feet to the ice machine in the corridor was "unsafe" (I was quite obviously able to walk, A, Ox4 and not on any monitors or oxygen at that time). Once I signed my AMA half an hour later, it suddenly became perfectly OK for me to get water myself and do not bother my poor CENA who was clearly at the very end of her wits and will that night.
    Last edit by KatieMI on Dec 16, '17
  13. by   canoehead
    Quote from KatieMI

    In this context, I find it interesting that patients who sign out AMA seem to be not authomatically "offered" wheelchair and expected to walk out of there on their own. I'd seen nurses and aides getting very grudging about pushing out a patient who signed AMA paperwork but was clearly not fully ambulatory and needed help to get into private car with family waiting in it on "drop in/off" spot.
    If someone is signing out AMA, and I think its a terrible idea, I will remove all the medical equipment, but I wont assist them with dressing, or calling a ride, or walking out. Lots of times, just trying to figure out the phone to call for a ride flummoxes our confused folks. Or they get up to try and dress and realize how very weak and sick they still feel, and decide to stay.

    If going home is unsafe, they still have every right to do so, I'll work through the plan verbally, but I won't help them act on a bad decision. I don't know how that would fly in the customer service driven hospitals, but sending an 80yo guy home in a taxi, in slippers, in the winter for example...seems like a bad idea. If he gets there totally on his own steam its more defensible than if I dressed him, called the cab, and wheeled him to the curb. I can document his independence and decision making through the process, and talk him through "what if you have this problem at home?"
  14. by   mmc51264
    I work on an ortho unit so everyone leaves in a w/c simply because they are only ambulating a few yards or feet. They are safe to go home with assistance, but would never make it to the front door. We let pts walk that can (shoulders, etc)

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