How do you do it? - page 2

does anyone have any ideas or techniques to incentivize nurses to get their discharges ready and out so new patients may be admitted and diversion can be avoided? thank you in advance for your... Read More

  1. by   Medic/Nurse
    I'll agree with TazziRN on this one - more nurses equal faster throughput.

    My DISCHARGED PATIENTS go to the bottom of my "nurse priority" scale, pretty fast - if I'm already running at warp speed.

    One trick was using "Admission Nurses" this did shorten the process of new to bed.

    I think a Discharge SWAT team may be needed!?

    A trick I did see work at times -

    When ED saturation occurs - - rather that divert - - the entire hospital goes into Decompression Mode. Supervisors, case managers and the like all get involved. A "team" approach - does work at times (Everyone - from dietary to housekeeping to staffing to facilities has ONE goal). D/C'ed patients are sent out, ICU beds are made available if possible, MS admits are taken up without delay and with hold orders if necessary. Anyway, the point is this - no the nurse who is still an admission behind with 7 - 9 other patients is NOT asked to drop everything!
    Also, this is not used to excess - it only occurs when it occurs.
    Also, there are obvious limitations - # beds, # staff etc.

    Good Luck - as we are all aware - DIVERSION is a difficult issue.
  2. by   RNinSoCal
    At my current facility we have a "Home by noon" policy. The doctors can write DC orders in the evening or early am and we send them home as close to noon as possible which opens the floor for PACU transfers and ER admits. Discharges are very streamlined here with MDs writing most of the instructions. It is hard to delay a discharge when it is a hospital wide policy AND the MDs are on board with it.
  3. by   Sheri257
    Quote from Tweety
    Stop bugging and harrassing me to get my patient out. It will get done when it gets done to the absolute best of my ability.

    And just because I discharge someone doesn't mean I'm available right then and there to immediately accept another patient. I have other patients.
    I once saw the Med-Surg director announce that any nurses who were "sitting" on discharges would get written up. At the time, we were discharging patients as fast as we could. All I could think of was ... wow, no wonder they were short of RN's. Needless to say, I won't be working there when I graduate.

    At the second hospital I worked at ... I didn't see that kind of pressure at all. While they did try to discharge patients by noon ... management didn't ride the RN's about it. And, if the RN's couldn't take more admits they'd say so ... and that was the end of it.

    :typing
    Last edit by Sheri257 on Aug 30, '06
  4. by   Tweety
    Quote from lizz
    I once saw the Med-Surg director announce that any nurses who were "sitting" on discharges would get written up. At the time, we were discharging patients as fast as we could. All I could think of was ... wow, no wonder they were short of RN's. Needless to say, I won't be working there when I graduate.


    :typing

    I think that's what bugs me the most is the suit's presumption and judgement that we're "sitting" on discharged and deliberately dragging them out. I'm sure that happens otherwise there wouldn't be that stereotype.

    While I might not understand the ramifications of ER diversion (but I'm smart enough to know that each ambulance that drives by our busy and unsafe ER is lost revenue) they truly don't have a clue what I'm doing either.

    My apologizies to the original poster for highjacking the thread.
  5. by   Sheri257
    Quote from Tweety
    I think that's what bugs me the most is the suit's presumption and judgement that we're "sitting" on discharged and deliberately dragging them out.
    Well ... I'm sure it can look like that's happening but, it's often not the case. If you call the family at noon and nobody's home because they are at work or ... they can't come pick up the patient right away because they're at work ... there's not much you can do about it. What are you supposed to do, dump the patient in the parking lot?

    :typing
  6. by   Tweety
    Quote from lizz
    Well ... I'm sure it can look like that's happening but, it's often not the case. If you call the family at noon and nobody's home because they are at work or ... they can't come pick up the patient right away because they're at work ... there's not much you can do about it. What are you supposed to do, dump the patient in the parking lot?

    :typing
    Our VP of patient care services (not a nurse) said we need to dump them off at the coffee shop or cafeteria and make them wait. I wasn't at that meeting, but the room apparently got very quiet and stunned at this "solution". I'm glad I wasn't there to ask "are you going to help him to the bathroom and clean him up, and bring him pain medicine?". Sheesh.

    Most of my discharges aren't easy, and there's a lot to do and we are getting much better with case managers at planning ahead. But still the time of order and the time at the door sometimes involves issues outside of my control.

    Again, I apologize to the OP.
  7. by   gr8greens
    We have two admit/ dc nurses for the whole house at the present time. It works out very well....when they are on. They're only part-time, and the days they're not here really stink! I work a 32 bed, very busy tele unit....high turnover every day. We'll be asked to take report from the cath lab or ER even before the bed is empty! Paperwork is just unbeleivable.
    More staff would help but we all know how that goes.
  8. by   banditrn
    Quote from Tweety
    Our VP of patient care services (not a nurse) said we need to dump them off at the coffee shop or cafeteria and make them wait.
    Geez, wonder what JCAHO would have to say about that?!!
  9. by   Creamsoda
    Thats not a fair question. We ALWAYS try to get them out the door fast, but its almost always beyond our control. So yes, smaller patient ratios would help. Alot of times, the patient's ride cant come, or is late ect.

    Cher
  10. by   sjt9721
    Quote from Tweety
    Stop bugging and harrassing me to get my patient out. It will get done when it gets done to the absolute best of my ability. I realize "staff nurses don't understand the raminifactions of diversion" quote from our VP of Patient Care Services, but asking me every five minutes and bugging me to death about it isn't going to get them out faster. And each time I have to stop and explain what is taking to long only adds to it.

    And just because I discharge someone doesn't mean I'm available right then and there to immediately accept another patient. I have other patients.

    I promise that as a professional I don't dilly dally and obstruct admissions and transfers because I'm lazy and am playing games.

    Don't get me started. Sorry. Very sore point with me.
    Tweety,

    I understand your frustration. It's too bad we can't clone all the nurses like you (and me of course!) that are professional and take care of business. But I'm sure you realize that not every nurse practices that way. The challenge is how to motivate those who don't while appreciating those who do!

  11. by   nuangel1
    also need to look at other reasons for delay besides nursing sometimes its a surpise d/c for both pt and staff .sometimes drs don't come in until late to do d/c orders .maybe its a ride or pickup for pt etc.i have worked at hospitals that have an out by 11 am expectation just so pts can be d/c and pt admitted it wa stressed to md and nursing that this was a priority .tweety i also have worked the floors and sympathize with your frustrations .especially being "buggrd q 5-10 min)to do d/c.
  12. by   mtnmom
    have an "discharge team" a float nurse or nurses, depending on the size of the unit(S). (and they could help with admits too)

    Make staff understand that it is a 24/7 job and to take advantage of "teachable moments" to get some of the d/c instruction out of the way.

    Lastly, involve case mgmt and other disciplines to make sure that everything is in place for the person to go home...

    Make sure that the person has a dependable means of transportation home. Don't wait until they are signing d/c papers to do this.

    Just ideas...but the most important issue is teamwork.
  13. by   suzy253
    Quote from nuangel1
    also need to look at other reasons for delay besides nursing sometimes its a surpise d/c for both pt and staff .sometimes drs don't come in until late to do d/c orders .maybe its a ride or pickup for pt etc.i have worked at hospitals that have an out by 11 am expectation just so pts can be d/c and pt admitted it wa stressed to md and nursing that this was a priority .tweety i also have worked the floors and sympathize with your frustrations .especially being "buggrd q 5-10 min)to do d/c.
    Yep..I agree, especially being 'reminded' constantly about it. Then there's the elder dear where you just got an order to DC his foley but he can't leave until he urinates, which can take awhile...and it goes on and on and on. Nothing I like more than discharging a patient but other time restraints or circumstances don't always make it an easy process.

close