I wish they had to stay and watch the chaos

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Just once, I wish MDs had to stay and watch the chaos that ensues when you discharge 12-15 people at roughly the same time in one day. Oh yeah, all the discharges were put in about 4 hours before shift change, with most being completed by 30 minutes prior to shift change. Next shift walked into 10 "freshly cleaned" open rooms and 5 discharges waiting to leave. TOTAL chaos. Every nurse has 5-6 patients with everyone having multiple open rooms. Transfers, admissions from ED, direct admits from MDs were the name of the game for the next 5 hours. Throw in HS med passes, PRN pain meds, assessment needs, verifying ALL the new stuff that has to be done for transfers/admissions, as well as a few rapid responses while we are at it too. UGH! I WISH THEY HAD TO STAY TO WATCH TO SEE HOW WRONG IT IS TO CLEAR HALF THE FLOOR IN ONE SWOOP! Rant over.

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Specializes in Med/Surg, Ortho, ASC.

I totally get the issue and can easily imagine the chaos. However, I can't figure out a decent answer.

Assuming that multiple docs are discharging on the same day.....how are they to know (or care) that 10 others docs just discharged their patients in the last hour? Should there be a maximum number of discharges allowed per day?

I sure wouldn't want to be the patient that had to wait an extra day in the hospital because the daily quota of discharges had been met. Maybe dedicated discharge nurses who operate outside the staffing/census ratio?

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Wow 4 whole hours of buating tail at the end of your shift and 5 whole hours of busting tail at the beginning of a new shift.

These truly are the times that try men's souls.

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Specializes in Trauma, Orthopedics.

If you have 5 to 6 patients AND several open rooms per nurse..... that chaos isn't all on the docs. Wow. Sounds like your staffing is a disaster.

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Specializes in Critical Care.

I don't agree that the Doc's are in the wrong by discharging patients. While they might be writing the orders "in one swoop", you should have a pretty good idea of who's got the potential for discharge, making the actual order just a formality in the process.

I think what you're complaining about is overall staffing levels and excessive workload which is valid, but just not discharging patients would be pretty counterproductive in terms of reducing workload, so would having the Doc just write today's discharge orders a few at a time; would you rather know now or even later in the day that your patient is to be discharged today?

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Its pretty clear that this is a "flow" problem and not an MD one.

Sounds like your hospital needs better leadership

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Specializes in Trauma, Teaching.

Would you really expect a doc to come in 5 different times to discharge patients one at a time?

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The actual discharge orders usually get written after the doctors have rounded on all the patients, written orders for everyone, put out a few fires, and when things slow down, then they get around to discharge orders. That is one reason patients seem to leave at the same time.

The overall problem seems to be "bed traffic control". Is there a house supervisor who staggers transfers and admissions so you don't totally get overwhelmed?

I have the feeling that you work 3-11. That is the shift that is always hit the hardest with admissions.

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Specializes in Leadership, Psych, HomeCare, Amb. Care.

Yes, it is a flow problem to try to discharge a large number of patients all at once. Obviously everyone can't be first, and we have a problem with unhappy patients who were "discharged by the doctor," an hour or two ago, and the paperwork is not yet done.

What slows you down? Not knowing who is leaving, not doing anything until the discharge is actually written, delay in clearances from other doctors? Can you get the doctors to preschedule discharges the day before? Can nights start with the discharge paperwork?

is this everyday, or one particular day of the week? Would it help if one person focused on discharges during peak times?

maybe there needs to be a discharge committee to tackle this.

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Same two docs - we have hospitalists - 2 to a floor per week. They sit next to each other at the computer when they do things and talk about pt before discharge.

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Let me say that I walked into this chaos at the start of my shift. We had no idea all these people were going to be discharged that day; the "potential discharges" for the day shift that morning was 3. Every few shifts, there seems to be a "mass discharge" between 1500 and 1900 of people who should have been discharged but weren't for one reason or another. The ED gets backed up (it's massive) so we get directives to ship out anyone who can go, PRONTO. This leaves the night shift with report to just about every nurse as the following - "You have 6 pts, but pt 1 is leaving and needs to have discharge paperwork printed/completed/reviewed/scripts/transport called, pt 2 just left and the room is being cleaned for a transfer, room 3 was admitted this morning and needs blood tonight, room 4 and room 5 are regulars, and room 6 is being discharged right now with another admission already called for from the ED." That means in the span of about 2-3 hours I'm expected to collect and review with the discharge, take an admission (or 2 depending on how quick I get the discharge done), take a transfer, start my evening med pass, AND figure out how to start that blood at some point.

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I agree that bed placement/house supervisor should have a better idea, but they just don't. Our hospitalists could say "potential discharge" on someone for their one to two weeks but find some SMALL thing to keep them each day that could be dealt with outpatient, then when they need the bed, out they go.

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I know the docs are just doing what they are told to do as hospital employees, but when they walk in and tell someone "you are discharged" - they should at least KNOW the process and how long it can take even in the best circumstances - because we have so many things we have to print/give them/go over with them before they can leave, plus EVERYONE has to be transported by ancillary staff but escorted by CNA/Nurse to the outside of the building. If someone has to be transported by ambulance, they are at the mercy of whenever the crew can get to them. When you discharge 15 from one floor, in a very large hospital - image the backup just for transport when this is happening on half the floors in the hospital.

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It really is a systemic problem, but it's never going to be fixed because it's all about the money and a very reactive rather than proactive set up. Sad.

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Wow 4 whole hours of buating tail at the end of your shift and 5 whole hours of busting tail at the beginning of a new shift.

These truly are the times that try men's souls.

Sorry scottaprn but I work on a very busy floor with very little downtime for anyone. We "bust tail" pretty much the entire shift.

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Specializes in Inpatient Oncology/Public Health.
Wow 4 whole hours of buating tail at the end of your shift and 5 whole hours of busting tail at the beginning of a new shift.

These truly are the times that try men's souls.

Gold star for your snark and adding absolutely nothing to the discussion!

To OP: that sounds like a nightmare. Definitely seems like both flow and staffing should be addressed.

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