Discharged directly from ICU?!?!?

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Hello,

I am working in the outpatient setting and becoming aware of (what I think?) is a new practice: pts being discharged directly from ICU. One was discharged to home on a vent - family totally unequipped, she ended up back in the ER.

Another experienced multiple fractures post-trauma and was sent home unable to walk, flat on his back. Needless to say he had trouble following up for his next appointment (don't know how they expected him to get there?) and almost dropped completely out of care.

Is this a common practice? These patients did not have insurance and had some language barriers. But still. This strikes me as unethical and was not occuring when I worked in the ICU... even with these types of patients.

Can anyone shine some light on this for me... ?

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Specializes in CVICU, ICU, RRT, CVPACU.

We discharge people to home sometimes, but not in the situations you have described. It happens in almost all hospitals.

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Specializes in ICU/Critical Care.

I've done it before. It's very rare though.

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Specializes in SICU, Peds CVICU.

Same here. Every now and then we'll discharge people home, but only after they've been waiting for a floor bed for a few days. They're patients that are stable and would be ready for discharge home from the floor anyway. It sounds like those patients should have been discharged to an LTAC or rehab facility.

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Specializes in Spinal Rehab (2yr), neuro,currently ICU.

we discharge a few cases directly home, first they have to be " non-complex" patients i.e patients who have been mostly well before admission, and will return to normal funcntion after discharge, have to be very stable while in ICU and also in the same instance as Sicushells mentioned,

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Same here. Every now and then we'll discharge people home, but only after they've been waiting for a floor bed for a few days. They're patients that are stable and would be ready for discharge home from the floor anyway. It sounds like those patients should have been discharged to an LTAC or rehab facility.

That was my situation. I should have been moved out of the ICU after the first day, but there were no beds, so I stayed there another day and a half until I was discharged. When I sent a thank you note to the hospital, I mentioned that I liked the large, private ICU room. I like to think that my note helped to encourage the hospital in its move toward private rooms.

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Thanks for your replies. This was my gut feeling also but I didn't want to pursue it unless it was truly out of the ordinary.

After a few more patients let out into the world I did some follow up with the unit social worker. Turns out.... the social worker went on vacation for a few weeks, there was no one covering, so they started discharging uninsured ICU patients who needed LTAC or rehab to home (needed to free up the beds). Whoa. It should be illegal to send someone home like that. I hope I never see it again.

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Specializes in ICU.
Thanks for your replies. This was my gut feeling also but I didn't want to pursue it unless it was truly out of the ordinary.

After a few more patients let out into the world I did some follow up with the unit social worker. Turns out.... the social worker went on vacation for a few weeks, there was no one covering, so they started discharging uninsured ICU patients who needed LTAC or rehab to home (needed to free up the beds). Whoa. It should be illegal to send someone home like that. I hope I never see it again.

It is unethical but unfortunately it still happens, not very often, but there are cases of people that have been DEPORTED to a 3rd world country while they were still in a coma! If you look on the internet, I think you may find articles about it and I believe it's under "medical repatriation". Besides this, there are hospitals that "dump" homeless people back on the streets because they can't pay, but they're still sick!!!

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Specializes in SRNA.

Yes, I've discharged patients to home, but not under those horrible conditions! These were stable patients that were in the ICU for days beyond having orders to move to the floor.

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This seems partially a social service problem, I would think the facillity would have a replacement when she/he is on vacation. The vent patient, if not on insurance would surely have qualified for medicaid or equivalent, some of the others also. That would also have helped cover for outpatient care which obviously was needed. Even if short a bed, it seems to me these types of patients would have been transferred to a "lower" bed for a day. Perhaps your facillity needs to "adjust" beds in these instances. Our facillity at one point even opened and staffed some outpatient beds for the overflow. Also these types of patients can't be discharged without the OK of the admitting MD. Does it appear to be the same one all the time? Possibly your facillity needs set out a policy regarding these types of patients?

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Specializes in Critical Care.

Recently my unit has been experiencing this d/t the trauma docs not feeling comfortable with the care pt's are getting on the floor. We have a pt who is completely stable that trauma has said we aren't allowed to transfer to the floor only to d/c to rehab when he's ready. It makes for a very difficult situation especially when you're running so low on beds your 'bumping' people to MICU so you can immediately turn around and admit a new trauma. Frustrating and scary practice when you think about it...

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Specializes in Medical ICU.

So far, in my unit, I've only seen a few cases discharged to home:

1. AOR

2. Terminal extubation at home as per family's request

3. Stable patients on home vent (i.e. BIPAP/CPAP)

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