Discharging by Wheelchair

Nurses General Nursing

Published

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?

We actually have to document if the patient refuses a wheelchair escort and walks to the elevator to leave the floor and exit the facility for discharge.

One patient's family member (their husband/caregiver) brought her wheelchair from home and said that he had it covered and refused a hospital escort to the car. She fell getting into the car and was our next ER patient.

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Specializes in Critical Care.
I've re-read your posts, and I can't get a picture in my mind of exactly what type of patient you are talking about in the instance of YOUR facility and the lawsuit. At first, you stated it was a patient who fell at home and got a "slam dunk" decision because of the argument of distance. You claim it's similar distances (whose home are we talking about that is "a few hundred feet"?!), which is just definitely NOT typical. But, you also acknowledge that some people need a wheelchair for discharge but not at home if appropriate considerations have been made--sometimes, that consideration is the layout of their home without any special accommodations. Then, you go back to the blanket wheelchair rule.

I just don't understand your patient situation that allows you to continually say "well, that doesn't apply and that doesn't apply." So, to be clear in your patient's situation, the patient you are talking about in your facility was taken by wheelchair because the nurse thought the patient wasn't able to ambulate independently all the way to the exit. It was noted that the patient's home was mansion of a "few hundred feet", fell, and sued for inappropriate discharge? If the patient's home was smaller than a "few hundred feet," then the distance argument is relevant!

Had the nurse made an assessment specific to the patient that they weren't able to ambulate independently to the exit (and the other considerations that would go along with that) then there wouldn't have been an issue. The problem was that the nurse claimed that basically no patient ever can reasonably be expected to ambulate independently to the exit, which would then justify a blanket rule, he argument was similar to what many have said here.

A main part of her claim was that the distance to the exit always far exceeds what a discharged patient can walk. In reality, these are definable distances. The distance a patient should be able to walk independently is 150 feet without there needing to be considerations for their activity tolerance. The other side was well prepared for this argument, and asked our nurse how far she thought it was typically from a patient's room to an exit where a patient could be picked up.

Even at large facilities it's not anywhere near what she thought the distance was. One of the largest facilities in the US, the Cleveland Clinic, was used an example, the longest distance required to ambulate from a room to an exit there is about 185 feet. Even in "big box" style hospitals, which are pretty unusual, it's not much farther. Maybe it's an issue of how we perceive distances, I asked around at work what people thought the typical dimensions of a Costco was, the shortest distance of length or width that anyone guessed was 1000 feet, someone guessed 30,000 feet. The actual dimensions of a typical Costco is actually 300 feet by 300 feet.

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Had the nurse made an assessment specific to the patient that they weren't able to ambulate independently to the exit (and the other considerations that would go along with that) then there wouldn't have been an issue. The problem was that the nurse claimed that basically no patient ever can reasonably be expected to ambulate independently to the exit, which would then justify a blanket rule, he argument was similar to what many have said here.

I don't know this case obviously - but your use of the word "basically" seems to say that the nurse didn't actually say that the reason for the blanket policy is that no patient can ever be reasonably expected to ambulate independently to an exit. In the simplest sense, it's a strawman - because that's clearly and very obviously not the reason there would ever be such a policy. It's nothing but unfortunate that this nurse entertained this crafty line of argument when put on the spot. More realistic reasons for such a policy are that 1) The distances or circumstances are not the same as they will be at home and for a variety of reasons may not be as doable as they will be at home. And 2) Stuff happens - why take the risk? Why don't new parents carry their babies out of the hospital?

A main part of her claim was that the distance to the exit always far exceeds what a discharged patient can walk. In reality, these are definable distances. The distance a patient should be able to walk independently is 150 feet without there needing to be considerations for their activity tolerance. The other side was well prepared for this argument, and asked our nurse how far she thought it was typically from a patient's room to an exit where a patient could be picked up.

Then that is where the education is needed going forward: That the discharge planning must show that assessment and planning have been done with regard to the considerations. The wheelchair discharge is neither here nor there. If the nurse simply would've replied that the reason for the w/c ride was because the walk to the exit had been assessed to be more/different physical activity than the patient would need to do at home, then there's nothing else to argue about (unless the plaintiff has a better way to show that, in fact, the discharge planning was not appropriate).

Even at large facilities it's not anywhere near what she thought the distance was. One of the largest facilities in the US, the Cleveland Clinic, was used an example, the longest distance required to ambulate from a room to an exit there is about 185 feet. Even in "big box" style hospitals, which are pretty unusual, it's not much farther. Maybe it's an issue of how we perceive distances, I asked around at work what people thought the typical dimensions of a Costco was, the shortest distance of length or width that anyone guessed was 1000 feet, someone guessed 30,000 feet. The actual dimensions of a typical Costco is actually 300 feet by 300 feet.

Understood. I guess I don't know what all the rest of us are missing here. I was visiting my elderly neighbor at his home last week and at some point he got up from his chair in the living room to ambulate to the restroom. I didn't measure the distance, but he took ~25 small steps to make it to the doorway of the RR. The kitchen is about the same distance. His bedroom would've taken ~ 35 steps from his chair, and has an en suite (2nd) bathroom so at night he's only about 5 steps from the RR. He ambulated steadily with his walker. I don't know what else to say...the number of steps he accomplished when I watched him walk to the RR wouldn't have taken him to the elevator on plenty of units. I hesitated to even write all of this out, though, because it doesn't matter. It is not the issue. It's nothing more than what a lawyer managed to make look like the issue. It doesn't matter whether nurses accurately estimate the length/width of Costco - plenty of people simply do not have to walk +/- 50 yards to get around in their own homes.

We let discharged patients ride our elevators, too, even though some of them have stairs in the home that they will need to navigate. The whole argument that was unfortunately successful in the case you mention, is ridiculous. Which is why when you first posted I felt that the hospital's lawyers must have fallen asleep instead of properly defending this.

The answer to this whole argument isn't to question why we would discharge patients by wheelchair even when they are expected to ambulate in their own homes - the answer is simply to make sure appropriate assesssments and discharge planning are accomplished.

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The answer to this whole argument isn't to question why we would discharge patients by wheelchair even when they are expected to ambulate in their own homes - the answer is simply to make sure appropriate assesssments and discharge planning are accomplished.

I proposed to MunoRN that the question was one of appropriate discharge planning early on in the thread, and he denied that the situation involved inappropriate discharge planning.

I happen to agree with you.

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Had the nurse made an assessment specific to the patient that they weren't able to ambulate independently to the exit (and the other considerations that would go along with that) then there wouldn't have been an issue. The problem was that the nurse claimed that basically no patient ever can reasonably be expected to ambulate independently to the exit, which would then justify a blanket rule, he argument was similar to what many have said here.

A main part of her claim was that the distance to the exit always far exceeds what a discharged patient can walk. In reality, these are definable distances. The distance a patient should be able to walk independently is 150 feet without there needing to be considerations for their activity tolerance. The other side was well prepared for this argument, and asked our nurse how far she thought it was typically from a patient's room to an exit where a patient could be picked up.

Even at large facilities it's not anywhere near what she thought the distance was. One of the largest facilities in the US, the Cleveland Clinic, was used an example, the longest distance required to ambulate from a room to an exit there is about 185 feet. Even in "big box" style hospitals, which are pretty unusual, it's not much farther. Maybe it's an issue of how we perceive distances, I asked around at work what people thought the typical dimensions of a Costco was, the shortest distance of length or width that anyone guessed was 1000 feet, someone guessed 30,000 feet. The actual dimensions of a typical Costco is actually 300 feet by 300 feet.

I proposed to you earlier in the thread that this situation appears to be a question of appropriate discharge planning (which includes the nurse's assessment of the patient for discharge). That is the crux of the problem, not that we discharge patients in wheelchairs when they are expected to walk in their own homes.

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Then that is where the education is needed going forward: That the discharge planning must show that assessment and planning have been done with regard to the considerations. The wheelchair discharge is neither here nor there. If the nurse simply would've replied that the reason for the w/c ride was because the walk to the exit had been assessed to be more/different physical activity than the patient would need to do at home, then there's nothing else to argue about (unless the plaintiff has a better way to show that, in fact, the discharge planning was not appropriate).

Exactly.

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Specializes in Med-Surg, CCU and School Nurse.

Last winter, I was 38 and reasonably healthy, I became extremely ill (idiopathic dilated cardiomyopathy with EF

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Specializes in critical care, ER,ICU, CVSURG, CCU.

I blatantly refuse to be discharged via wc, and so does my husband.........( patient bill of wrights).

If I'm ambulatory , stable, we can walk to our cars .....

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I blatantly refuse to be discharged via wc, and so does my husband.........( patient bill of wrights).

If I'm ambulatory , stable, we can walk to our cars .....

Would that be waithwrights? Or is it wraithwights?

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