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Discussion

Estimating discharge date

I'm a new LPN, work in a hospital, and am still paired up with a nurse for orientation. One of my patients (young adult male ORIF of tibia POD #1 no significant prior history) asked me about noon when the doctor lets patients discharge. I told him that it usually occurs when vital signs/labs are stable, pt. can ambulate safely (he walked 75ft w/PT nwb), and pain is controlled and it could possibly happen tomorrow. I told the nurse I was paired with this and she was upset and told me we should never tell patients that sort of thing because they might get upset if they have to stay an extra day. The nurse was from a different floor. I didn't tell the pt. anything definite. I was confused because over the past few months the empashis on estimated discharge dates (EDD) has increased on our floor to help patients be prepared.

Is this out of the scope of practice for an LPN/RN to tell a patient this? Does your floor emphasize EDD? Do they help patients or have you ever encountered someone really upset because of it?

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    Discharge planning starts on admission.

    In the future, however, I would say something along the lines of "that is something that you should speak with the MD about when she/he comes to see you today. We want to be sure that you can ambulate safely, and your pain is under control. We also want you to function, so we also need to be sure that any needs you have can be addressed at home. So be sure to have this conversation with the MD."

    There are many patients who hear "you can go home tomorrow" regardless of the "unless" or "perhaps" part of what else is said or how it is said.

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    We tell pts all the time what the expected EDD is. We are an ortho floor and it is exactly as OP stated. There are parameters and if they meet them, they usually go home. We always give the caveat that things may change but, usually the MDs have already told them this as well. It is no surprise.

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    From what you've told us, you didn't say anything definitive to the patient. You outlined the criteria for discharge and told the patient that this criteria could be met the next day. I personally wouldn't give a time frame like that because you don't know this patient and they could be the type that will hear what they want to hear and tell everyone and their dog that you said they were going home tomorrow.

    Easier to tell the patient that they will have to talk to the doctor about it.

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    I don't see anything wrong with what was said to the pt. When asked, I usually tell a pt the avg length of stay for a pt after the same procedure but also be sure to tell them that the attending & the surgeon both have to write discharge orders which are always contingent upon the pt passing their PT goals. Nothing wrong with including a pt & family in planning for discharge.

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