Survey: Are patients being released too early?[/

hoolahan, ASN, RN · Feb 4, 2002

YES, yes, yes, yes!!!

Speaking as a home health nurse, I answer an emphatic YES!!!

It also depends on the hospital. There is one hospital in my area that is really bad. I send approximately 50% of my new admits back to the hospital on the eval visit for things like persistent temp in post-op pt, elderly frail people with no caregivers who are unsafe to stay in their homes alone (maybe confused, etc...) pt's with new trach's and who have no needed supplies set-up. Family has never been instructed once in care!! Post-op's who haven't had a dressing chnage in 5 days, and now have a dehiscence when I remove the dressing. The list goes on!!! Like I said, it's mostly only one hospital.

Most of the others at least give the pt and family good teaching. If I do find people sent home too early from other hospitals, I find out it was from the pt's own insistance often times. I had one bilat total knee who refused rehab and was sent home with those dreaded CPM machines, but he was using them appropriately, and doing a damn good job of it.

To be devils advocate, for every pt sent home early, there may be one who asks to be sent home early and does well. I had one gastric bypass pt who just couldn't sit still in the hospital, she finally was sent home day 2, and she did great.

The ones who did not insist on being sent home are usually the frail and maybe confused elderly. The hospital I guess could not judge what this person's home environment could be like. Maybe they just can't make good judgement calls anymore and should not be home alone, or have no food in the fridge but a box of donuts and a small container of half and half. Those are the saddest. I'll never forget one man who, whe I walked in to the house, had tried to flush clothes down the toilet (guess he thought it was a washer) and had a flood in his pat. As I had walked down the hall to his apt, another neighbor did the Cuckoo sign with the finger beside her head. That was my first clue. I called his neice and told her he cannot be here alone, and then I called the doc. I helped the neice dress him for the hospital, all the while he was screaming, don't put me away! How sad.

laurel schultz · Feb 4, 2002

Brian, Let me tell you a brief synopsis of what I have been doing with my 85-year old, blind mother. I waited 12-hours in th ED for her to be admitted for acute CHF and pneumonia. The peumonia had been diagnosed several days earlier and was being treated unsuccessfully with Doxycycline at home, in an attempt to avoid hospitalization. She stayed 5 days on a respiratory floor, until her IV antibiotics were finished, and then sent to TCU without having ambulated independantly or feeling any better. 2 days into TCU I got a call from a social worker to set up a family meeting for discharge in 2 days. They wanted to send an 85-year old blind woman with a EF of 12, that had still used the bedpan, home by herself. I asked what the last X-ray showed and come to find out they had not done a repeat x-ray. When this was done, it showed unresolved pneumonia. When I asked why her EF was only 12, the nurse told me that she was too SICK to go for an angiogram. I asked how she did on the stairs, they had not tried her on the stairs. Needless to say my nursing education and valid questions bought my beloved Mum, 5 mores days of rehab. I bring her home today! Whats going to be there when we need it? :eek:

Heartsofangels · Feb 4, 2002

Yes, I believe patient's are being released too early. I am the 2nd shift supervisor of a 71 bed facility. Our10 bed sub-acute unit is mostly vent patient's and the hospital is always sending us new pt's or re-admits that are definitely not ready to come back. We have one lady who first came to us about a month ago who was a nocturnal vent and used a passy muir valve during the day. She turned blue a few times and is a full code so she was sent back to the hospital a few times and sent right back. This pt was eating til we found information in her chart saying she had an esophagectomy (I hope I spelled it right!) and her stomach had been pulled up. We discussed this with the Dr and her family and decided to have a J-tube put in. She ended up being sent to the hospital again because of a total whiteout of one lung and she just came back again full of fluid, the poor woman is a train wreck. She's not a noc vent anymore, she's just 40% cool mist via t- piece. I think some hospitals do release patient's too soon.

Cascadians · Feb 4, 2002

Too many horror stories; not enough time to relay.

RN "Discharge Planner" made rounds with Docs. 1/2 her salary came from insurance cos. and 1/2 from hospital. She was alert to any possible hint for any excuse to boot the pts out of hospital.

The day they tried to discharge an 89-year old man unconscious still having seizures to his clueless 88-year old petite frail wife was the day we knew it had gone beyond reason, science, logic, compassion, or conscience.

We have our own homecare biz and have been taking pts home very close to their ICU stays. A struggle to get any nurse to get discharge orders, supplies, and family education together before discharge. Mayhem out on the floors.

Every week it seems to be getting more rushed with pts not having been bathed for a week before discharge or given bowel care or temps under control or BS etc etc etc. We have to do bedside care just to stabilize and clean a pt enough to have the Care Car willing to put pt on stretcher for the trip home.

And we have to educate the family while dischargers itching to go to ask the Doc to get Home Health in with a visit scheduled within a hour of the pt arriving home so that the transition will be safe and all the quirks ironed out before disaster strikes and a quick re-admit is necessary.

We feel for all the families who have no support and are left with no help, no clue, and nowhere to turn. Assembly line turnover. Dangerous. Tragic.

thisnurse · Feb 4, 2002

weve had pts code at the door.

remember the good old days when docs perscribed the meds and decided when the pt could go home?

VickyRN, MSN, DNP, RN · Feb 4, 2002

I have seen both extremes. Patients staying forever in the unit, stepdown, or on the floor. Or patients literally being shoved out the door way too early at their peril. (Like patients who have experienced a massive MI, being sent home after two days--inexcusable, IMHO.) Not a whole lot of logic either way. Most of the time the lengths of stay in the ICU or stepdown unit have been appropriate. Sometimes, the acuity call is very, very off. Wrong patients assigned to the wrong area. I have seen patients in the ICU who really needed to be on the stepdown or on the floor--just not that sick; and I have also seen (when I worked stepdown) VERY sick patients there who REALLY needed to be in the unit! These bad judgment calls make for a miserable shift for the nurse involved, not to mention for the patients... But this is the subject of another thread....

fergus51 · Feb 4, 2002

YES. I work L&D/PP and it seems like we are sending women home before they can even parent properly. My earliest discharge was 4 hours after birth.

night owl · Mar 2, 2002

Lawyers and Insurance companies run this country, don't you know that? It's a shame when docs have to argue with these insurance companies saying, "If I send him/her home today, they'll die!!!" It's mind boggling!...It's a crime to me that the Ins. co. have the say as to how long you stay when it should be the docs decision. As long as you're paying for the insurance, it shouldn't matter how long you're in for. Isn't that the point of having insurance??? I can see if you don't have any, because then we all pay...BUT enough is enough already! This is where you should be able to sue these companies say if you're released too soon and you do die or you have extensive complications because of being released too soon. At least the families can benefit from the monies...oh,...and the attorneys.

You would think that while these old, frail, confused pts are in the hospital the social worker would look into his discharge planning and find out what are they going home to? Does h/s have family to take care of h/h? If not, then I would think it would be discussed for possible d/c to a LTC facility. I can't believe that some are d/c'd home to NO ONE...It should be against the law! It's like sending a young child home to fend for himself and that IS against the law. What makes it so different if they're old, confused and crippled? How sad is our health care system becoming?? It makes me really scared to even think that you or I could be put into that situation someday...No wonder some old folks commit suicide. And who's to blame?