Discharging patients/unit projects

[LouisVRN, RN]

At your hospital are you held to standards regarding discharging patients? ie. patients should be discharged in 2 hours. What do you think the main barriers you meet towards speedy discharges?

If your unit were to do projects with the goal of enhancing the workplace, policy compliance, patient and employee satisfaction what things would you want addressed?

[Ellekat]

We have no specific standards. After receiving the discharge order, I ask the patient what time they plan to leave (many of them need rides) and get the paperwork ready as soon as possible. I check back with patients at least once; if they are staying for several hours I check several times to see if something has changed and they need to leave earlier than planned/need pain meds, etc. Otherwise, I give patients a time frame when I will have everything ready for them to leave. Most are willing to wait 15-30 minutes if needed and often they need to wait until someone gets off work (after 5PM) to get a ride home.

For your question on unit projects-I would try to get management to actually work with us. We are treated like young children with no understanding that we have adult responsibilities away from the workplace. We are often lied to and management really seems to thinl we are too stupid to realize we're being lied to. There is no active education program and no contact with management-even our manager is never on the floor. The last day I worked she called and pulled our two aides off the floor while we were getting four admits (we have 30 beds on the floor, to give you an idea of the size) to clean out a storage area for her. This was during lunch, so none of us got lunch and none of us dared clock out "no lunch", as that's frowned upon. She didn't even follow her own ruling that everything go through the 'team leader"-a euphenism for charge nurse that allows them to not pay for additional responsibility-but just told the ward clerk to send the aides where she needed them without checking with what was going on on the floor. Getting administration to even talk with us, much less listen to us, would be a major project.

[RNperdiem, RN]

A few things seem to slow down discharges.

A patient needs to be accompanied by a RN or CNA or transport tech for discharge out of the hospital. Sometimes they are all busy.

Sometimes you can't find a wheelchair when you need one. Maybe they are in use transporting others.

The doctor has written for discharge but there is a delay in writing discharge orders, prescriptions and all the paperwork that needs to be done first.

The patient is ready, but their transport person is not here yet.

[Flo., BSN, RN]

I work on an ortho floor so alot of the times the D/C is contingent upon being cleared by PT / OT and that can sometimes take hours! Other times I may have 3-4 discharges at the same time and you just can't get all that done in 2hrs.