Discharging by Wheelchair

[MunoRN]

I've always been perplexed by the practice of discharging a patient, who will be independently ambulatory upon discharge, by routinely taking them to the hospital exit in a wheelchair. In my experience this opens up the hospital to significant liability issues, is there a rationale that justifies this that I'm not seeing?

[mmc51264, BSN, MSN, RN]

I work on an ortho unit so everyone leaves in a w/c simply because they are only ambulating a few yards or feet. They are safe to go home with assistance, but would never make it to the front door. We let pts walk that can (shoulders, etc)

[JKL33]

So for everyone who might be weakened in the slightest, or have one of a gazillion other temporary or chronic situations that might make them at risk for any kind of mishap in the home, we should discharge them to rehab, and if they don't like that idea they can sign out AMA.

This situation, Muno, is someone getting smart enough to realize we're between a rock and hard place. We already know that if they have the slightest mishap on their way out the door, someone will say it's our fault. Someone will make a case that the incident happened because they were weak or tired or deconditioned or had meds on board, or our floors were slippery or whatever. So we push them in a wheelchair. Now when they get pushed in a wheelchair they say it's proof that we knew they couldn't walk? What am I missing? How is this wheelchair practice not defensible in court?

ANY patient could go home and do anything and then turn around and say we shouldn't have sent them home. Look at the people who are mostly narcotic-naive that we sent home with narcs and/or benzos just for obvious starters. Or meds that lower their blood pressure. Or meds that make them have to go to the bathroom too much and they tripped because they were in a hurry, or an oxygen extention in which they got tangled...

While smoking...which we told them not to do.

This idea that even when reasonable discharge planning is done we are still responsible for what happens in the home is over the top and a somewhat a Pandora's box type of idea. Someone's legal team should fight that tooth and nail.

[Cat365]

ER nurse here, so I may have a different outlook/situations than inpatient but I always ask. Do you want a wheelchair or do you want to walk? Some that I think would be perfectly fine want the wheel chair, but that's life.

It does help that as an ER our exit is not all that far from any of our rooms.

[JBudd, MSN]

Same in my ER. We simply don't have time to escort every pt out. They get discharged in the room, and have to find their own way to the lobby and freedom.

From the floors, as many others have said, it is a long way to the parking lot. Just because you can walk doesn't mean you should. I've always been told the liability issue as well.

[Been there,done that, ASN, RN]

I have worked in many facilities. Some insisted on wheelchair to the car, some gave the nurse the discretion to chose if a patient can walk out on their own.

This is a question for the WELL paid hospital lawyers and hospital board to answer.

[jodispamodi]

My facility doesn't require patients be dc'd by wc, on older and ortho patients I offer it, others usually just walk off the unit under their own power, some even leave by themselves without another person with them, depends on last dose of narcotics. I've had surgeries were I was made to use a wc, and others where I was allowed to walk off.

[K9lover, ASN, RN]

I think it is liability which dictates the wheelchair. They may be able to run a 10K but if they fall on hospital property a lawsuit will be forthcoming. If they fall while in-patient hospitals have made this the punishment of the nurse right up there with a police officer involved shooting. I'd add that people were not discharged so ill in years past, hard to believe but they sepnt 3 days in the hospital for a simple chole!

[klone, MSN, RN]

If they fall while in-patient hospitals have made this the punishment of the nurse right up there with a police officer involved shooting.

Not understanding

[MunoRN, RN]

I should clarify I'm not referring to patients where an inability to ambulate a reasonable distance has been a consideration in discharge planning, and where appropriate arrangements have been made to address this after discharge. I'm referring to considering this to be just a standard rule for everyone and where no reasonable argument can be made as to why they are clearly unsafe to ambulate to the pick-up area even though typical ambulation at home is about the same distance.

[Accolay]

From a med-surg floor, we would have PT pass patients prior to discharge if there is a question about ambulation. We have no policy stipulating giving wheelchair rides. If they are good enough to discharge home, I guess we figure they're good enough to walk out. Of course there are always patients that are borderline, PT pass or not... I would help the patient and their families with a ride to the exit.

Sometimes I'd push someone out with a wheelchair to be nice, since they've been sick and are still kinda tired and have been in bed for a few days. I can also remember patients I point to the door, this including AMA patients; if they are deemed capable to sign out AMA, then they can walk out

[MunoRN, RN]

So for everyone who might be weakened in the slightest, or have one of a gazillion other temporary or chronic situations that might make them at risk for any kind of mishap in the home, we should discharge them to rehab, and if they don't like that idea they can sign out AMA.

This situation, Muno, is someone getting smart enough to realize we're between a rock and hard place. We already know that if they have the slightest mishap on their way out the door, someone will say it's our fault. Someone will make a case that the incident happened because they were weak or tired or deconditioned or had meds on board, or our floors were slippery or whatever. So we push them in a wheelchair. Now when they get pushed in a wheelchair they say it's proof that we knew they couldn't walk? What am I missing? How is this wheelchair practice not defensible in court?

ANY patient could go home and do anything and then turn around and say we shouldn't have sent them home. Look at the people who are mostly narcotic-naive that we sent home with narcs and/or benzos just for obvious starters. Or meds that lower their blood pressure. Or meds that make them have to go to the bathroom too much and they tripped because they were in a hurry, or an oxygen extention in which they got tangled...

While smoking...which we told them not to do.

This idea that even when reasonable discharge planning is done we are still responsible for what happens in the home is over the top and a somewhat a Pandora's box type of idea. Someone's legal team should fight that tooth and nail.

I think it is liability which dictates the wheelchair. They may be able to run a 10K but if they fall on hospital property a lawsuit will be forthcoming.

I think there's some confusion about what "liability" is. Liability is not determined by geographic location, liability is in action or lack of action which a prudent person would have taken that would have avoided harm or injury.

If a person falls while walking down the hall of the hospital after being discharged, and there was no clear basis for believing the patient was not safe to do so then there is minimal liability. If the patient falls at home shortly after discharge, and it can be shown that staff recognized this risk but didn't alter their discharge plan, then the liability is with that decision (a decision that occurred in the hospital by hospital staff) not where the fall occurred.

Basically, the question that will come up in court is: "In your assessment of the patient's readiness for discharge, you agreed with the plan which included the patient being independently ambulatory. If that was the case why do you direct the patient to be taken to the pick-up area by wheelchair?" The answer seems to be "because the patient can't walk that far (typically a few hundred feet) without an increased potential for falling", which completely destroys the "they were assessed as safe to independently ambulate at home" argument.

[TriciaJ, RN]

So if you feel they aren't able to safely ambulate independently at the time of discharge, why do we assume that something magical will happen in the 5 or 10 minute car ride home that will suddenly make them safe to independently ambulate?

It's the distance involved. At home a person might be quite able to ambulate the short distances in his house and can rest when desired. Someone who's only a few days postop might have significant difficulty walking from his hospital room down the hallway, standing on the elevator and walking through a large hospital out to the patient pick-up area.