Do you have a process if you disagree with discharge of a patient?

[Codeblue1982]

I was wondering if any of you have a policy that allows you to go up a chain or consult someone if you disagree with the discharge of a patient. I had an IMC patient whose blood pressures were in the 200's and the physician was adamant about discharging the patient. I spoke with the medical director who tried to intervene this caused more problems which caused the pcp to tell me since I know everything she is signing off and I am responsible for managing the patient....no I am not making this up. After speaking with the patient and their family I told them they could go back through the ED or call the equivalent of a rapid response to get the ICU physicians over hoping they would intervene. We chose the rapid response route which worked. I do not think keeping this patient should have been such an issue. I am hoping maybe we can develop a policy at my hospital addressing issues such as these. If anybody has input I would appreciate it.

[tokmom, BSN, RN]

I go to my manager or the URDP. For some reason those two threaten the docs with their lives and the doc will back down. Many times our docs err on the other side and we groan when someone stays another day when everything is stable.

[toomuchbaloney]

The PCP that discharges a patient who is unstable and at risk for life altering or ending event is placing herself AND the hospital at risk for lawsuit should the worst happen.

I agree that your first recourse, when the PCP behaves as you describe is to bounce the situation to the House Supervisor or other nursing management that is present in the hospital for your support.

I am proud of you, you stood your ground and advocated for the patient, even when it was not easy and might adversely affect you. Kudos! You are a true professional!

[wheeliesurfer]

I would think that if they have had multiple issues with this physician, even if their policy is to not interfere with their practice protocols, etc. that the hospital could 'disapprove' of the MD's behavior by a loss of admitting privileges pending hearing. Also, if the Director agreed that this patient should have stayed but s/he didn't want to interfere with this other MD's practice, then the Director should have taken over this patient for 24 hrs or until discharge to make sure the plan of care was going in the right direction.

[KelRN215, BSN, RN]

I've worked at a place with a similar issue and the 'policy' was to discharge the patient directly to the ER.

That would get the hospital to deal with the MD... since they probably won't be paid for the second admission.

[Codeblue1982]

Thanks for all of your input, I have heard back from risk management about the situation and was informed it is going even above them to the medical director and the physician will be brought in front of a peer review board. This situation was certainly an eye opening experience and I going back I would not change a single thing I did. The only thing I might do in addition should it happen again is call our chief medical director at home when nobody else wants to get involved, that may get the ball rolling :)

[nurseprnRN, BSN, RN]

Thanks for all of your input, I have heard back from risk management about the situation and was informed it is going even above them to the medical director and the physician will be brought in front of a peer review board. This situation was certainly an eye opening experience and I going back I would not change a single thing I did. The only thing I might do in addition should it happen again is call our chief medical director at home when nobody else wants to get involved, that may get the ball rolling :)

:anpom: :anpom: :anpom: :anpom: :anpom: :anpom: :anpom: :anpom:

. . . . . . . . . . . . . Brava, Codeblue1982! . . . . . . . . . . . . .

:anpom: :anpom: :anpom: :anpom: :anpom: :anpom: :anpom: :anpom: