Discharging patients on the board

"How do you guys feel about this? Is this something you've seen consistently in your ED?"

I feel like you work for morons.

No, I have not seen this.

There is some logic to discharging somebody even if you are giving them the courtesy of using a room. but "discharging" somebody who still needs assessment or treatment is moronic.

If a patient is "discharged" and falls, will they expect you to triage the patient as a new visit?

So leadership at my local ED is obsessed with treat and release times and things are starting to be...creative. I came on shift this morning and was being given report when I realized one of the patients I'm getting report on isn't on the board (we use Epic). "yeah, management took them off the board since they're done and just waiting on transport home". But the patient is physically in the room. For another three hours. Later that shift, management "discharged" another of my patients from the room even though antibiotics were to be administered and she was supposed to be watched for an additional half hour for an allergic reaction and was in the room, on monitor and everything.

How do you guys feel about this? Is this something you've seen consistently in your ED?

Both of these situations represent nonsensical decision-making. The first requires clarification regarding whether the patient has been formally discharged or not (signed out). If yes, I will not take report. I have successfully refused this in the past. I will not provide informal surveillance to patients whose episode of care has ended. Adms are welcome to provide conveniences to these members of the general public if they wish; no nursing care (or involvement) is required.

The second scenario is much worse. (When you say discharged from the room, I will assume you mean electronically rather than physically, since their goal in pulling this move is to show a quicker through-put time.) I would go to them in person in real time and tell them that the case needs to be put back on the board. There would be an understanding that I'm not dropping the issue and won't be bullied about it.

Hang on for a rough ride or else get out now - you have additional badness coming your way. There is no limit to the lunacy that ensues in the context of inappropriate goal-chasing.

"Hello? Yes is this the joint commission?"

or

"Hi? Is this the state healthcare inspection agency?"

"Hello? Yes is this the joint commission?"

or

"Hi? Is this the state healthcare inspection agency?"

Or, you could initiate an ethics consult as a last-ditch attempt to deal with the issue internally.

Also, since throughput times are reportable to CMS, you can also report this kind of gaming the system to them. They don't take fraud lightly...although if you do that, brush up your resume as your hospital might not have long to live.

I feel like you work for morons.

+1

I forsee liability issues. Management will continue the practice until something bad happens. That's the line in the sand for them unfortunately.

Do the docs know this is happening? I wouldn't allow it. They simply need to create a new designation on the tracking board for patients awaiting discharge.

Wow. It makes we wonder if it's a financial move. If they are discharged on paper, but suddenly have to be readmitted (because they really weren't ready to leave,) does a new admission generate more money? I hate to sound like a cynic, and I freely admit I don't handle the Business part of admissions, but it does make me wonder.....?

It's all about throughput times. Outpatient Quality Reporting.

I've never worked in an ED where we kept patients on the census board after they had been discharged, it doesn't matter if they are still hanging out while waiting for a ride, they're still discharged and shouldn't be on the "board".

As for the patient who's gotten antibiotics, they should be discharged as well, there is no actual basis for holding a patient after their antibiotic has completed to watch for an allergic reaction.