Discharging pts. from hospital...

  1. I work on a very busy med/surg floor. Docs start making rounds at about 0730, and as the morning goes we are getting discharges and admits fairly close together. Of course, as any med/surg nurse knows, this is the busiest time of our day. We are just out of report, checking med sheets, getting blood sugars and insulins readied, passing trays, making a first round/safety checks on our pts, and getting pts off to surgery... and about a million other things, too!

    Because we are so busy with things that cannot be delayed, the early discharges are left until we are caught up on the higher priority tasks. We try to tell pts that it will be a little while to get their paperwork together, (usually tell them an hour or so). It seems some of them still get upset having to wait. You can't put off insulin and early morning meds, or getting pts off to surgery. Can't put off passing trays or feeding pts. Can't put off checking on our pts, (some of which need incontinence care,etc.). Can't put off the hurting pt needing pain med, or the vomiting pt, or the ones needing assist to the BR. Can't put off the newly arriving pt needing admission vs's,weight, IV start, etc.

    We have very few aides, so most of the above has to be done by the nurse. The charge nurse many times takes pts, too, so they are not able to help.

    So, how is it done in your hospital? Do you have a system
    that gets discharged pts out promptly? Do you ever have pts angry about having to wait to go home? What do you tell your pts that keeps them smiling, instead of scowling, waiting for their papers and a w/c?
    Last edit by plumrn on Apr 23, '03
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  2. 14 Comments

  3. by   New CCU RN
    I don't work M/S but, perhaps if your charge didn't take an assigment, they could be in charge of discharges?? Don't know if that would work?

    Or you have a posted policy that d/c don't start until after 10 or 11 am?

    Good luck.
  4. by   meownsmile
    My hospital even though small is very busy on the med/surg/ortho unit. We recently started pre-writing our discharge instructions when time warrents. It makes things go a lot quicker when the discharge is finally written and makes it smoother for the patient. We usually have a few things to add to the discharge instructions, but for the most part it can be written ahead of time even for a discharge to LTC or swing bed. Like today i discharged someone to a swing bed, but i had already written most of the discharge instructions Sunday when i had a few free minutes. I got her out before 11AM, even with docs making rounds and all the other stuff going on.

    I forgot to add the doctors love it, that way they can add or cross off anything they want for their patient. They can sign it and be assured it is what they want their patient to do or know.
  5. by   plumrn
    Our charge is forced to take pts sometimes, because of the amt of pts and nurses on the floor. Wish that could change.

    Thats a great idea to have a posted discharge time! Thanks for the suggestion.
  6. by   WashYaHands
    This may be a stretch, and may be a bad idea, but if the unit manager could produce the numbers and employee time related to discharges and admissions, it might substantiate the use of a part time discharge nurse to alleviate the burden to the staff nurses. Say, a nurse willing to work 4 hours in the morning, 5 days a week doing discharges only. I guess it would depend on how important patient satisfaction is to the facility. Just a thought.

    Linda
  7. by   P_RN
    Our discharge papers HAD to be filled out by the discharging physician. It served both as d/c teaching and d/c ORDER.

    We had access to computer discharge medication teaching sheets (like you get at the drugstore) and also handouts about sx to report. We kept these together in a discharge packet....eg total knee pack. ORIF pack.....etc. It seemed to work as well as anything Ive heard of otherwise.

    Team nursing also helped a LOT. One nurse could review with the patient while the other put out the little fires. We had to get them out because we'd be getting same day surgery postops as early as 9AM.
  8. by   rachel h
    Unfortunately, I know all too well what you are talking about. Usually when a pt is admitted I tell them that when it is time for them to be discharged, it may take a few hours before they can leave. And I start the nursing discharge paperwork as soon as I can upon their admission.

    What we also have on our floor is an LPN who 'flies' the floor and they can do pt discharges as long as the RN makes the teaching plan. Helps out tremendously in the real hectic times... also we usually have a flying squad nurse that we can call on for help, too.
  9. by   CCURN
    On the telemetry unit that I used to work on we would have a 3-4 patient assignment, and the night nurse would usually try to spread out the discharges and admits, so that a nurse wouldnt have a bad day. Patients can be very rude when they are ready to discharge, and I just ask them to wait. It can take about an hour, unless it is a complex discharge, and dont you just hate that....When the patient has been on the unit for days or weeks and none of the paperwork or transfer forms are complete, and its a monday morning..........................I remember once discharging all four of my patients on a day shift, I was so busy...........I had to ask some of them to wait,,,,,,,,,,,I usually deterimine who has to leave first based on the transport and how far they have to drive............People are usually understanding if you explain the delay...........
    Our facility also created the ADT nurse position (Admission, discharge transfer nurse), and they are incredibly helpful.......There is also a nurse circulator that can help out to. The ADT nurses usually help with admissions and transfers.....
    We also have a discharge area that the patients can go to if there ride is coming late, so that frees up a bed.
    Maybe it would be helpful for patients that when they are admitted they recieve information regarding the discharge process. Maybe they will be more understanding............
  10. by   plumrn
    Thanks for all the great replies and suggestions! It really is about the same all over, isn't it!?
  11. by   Agnus
    I just tell them up front that it will take a couple of hours but we should have you out of here by (here I give a realistic projected time) I tell them it might not happen exactly on time and they need to be flexible but I will do my best to get them out as quickly as possible.
  12. by   susanmary
    Don't you love the patients that are waiting to be discharged, fully dressed in their jeans/flannel shirts, etc. -- and are standing outside their door or at the nurse's station when you come to work EARLY? "The doctor said I can be discharged now." Sound familiar? Who can blame them? But I explain to them that I will do my best to get them discharged as soon as possible -- but I need to first check on all my patients, and after I pass out pertinent meds and insulins, then I will be happy to complete the paperwork. Usually works. If someone is really anxious, pacing -- I try to do my best to get them dc'd asap -- but that's not always possible. Rarely have to chase a doc down for d/c orders/scripts. We have RN case coordinators (bless them) that handle the d/c planning -- from beginning to end. The nurse assigned to the patient ultimately does the teaching, paperwork, etc.

    I find the docs that tell the patients they can be discharged anytime -- even when it's 7 am or so -- are the docs that have not written the d/c order, etc. So goes the cycle.
  13. by   webbiedebbie
    I run into moms being discharged but have to wait up to a couple of hours before baby is discharged!
  14. by   Rapheal
    Wow, we must work at the same place. How about when you get the order for dc, the scripts, and the one thing missing is the doctor's discharge papers and he/she has left the building?

    Sometimes you just can't do it all and someone has to wait. I have not found any good solutions because nobody wants to let their patient's wait to help me with my assignment. And the one and only time yet that I have tried to ask my charge nurse for help she cut me off before I could say anything by saying " I plan on staying 4 hours over to complete my work- not what do you need?" Uh nevermind.

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