Patients who stick around after discharge/legal risks

Specialties Emergency

Published

Hi, everyone...I've really enjoyed lurking here, now have a question I'm hoping someone can help with.

Anyone willing to comment on the risk-management/legalities of allowing patients to loiter in the waiting room for hours and hours after being discharged from ER? Our community hospital is having an issue with this and I'm concerned that it is a legal risk. For example, a patient who is VERY well-known to our department, comes by EMS and never has a way home - has abused every option available and burned most all bridges, so it is by sheer luck that he EVER gets a ride home. This patient always presents with the same potentially-serious complaint which (thus far) has never panned out to be anything. After being adequately evaluated and eventually d/c'd from ER, he ends up out in the waiting room and is more than happy to sleep there all night. Occasionally bothers other patients/visitors and staff by pandhandling for money or food or rides.

I think it is unwise legally to allow loitering on our premises - seems like a nightmare waiting to happen if the patient has some sort of 'event' while spending hours on OUR cameras just mere feet from our department (i.e. stops breathing while sleeping in one of our chairs and no one notices it -on camera- immediately). Most recently I have been told by management that I could make notes in the chart (post-discharge) with regard to the patient's activities ("sleeping", "reading magazine", etc.) which I think is even MORE dangerous for me to accept that level of responsibility. If I'm going to do that, I might as well keep the pt on tele until a ride can be found. :confused:

I think mgmt is leery of taking a 'hard stance' with anyone given that we are a community hospital, lest we appear un-compassionate. Also, there is a fear that if we call the cops, for example, the pt will just make the same original complaint again and end up needing to be re-seen in the ER even sooner than he otherwise would!

Thoughts? Especially comments related to the nurse's responsibility to discharged patients who don't leave the premises....and feel free to let me know if I'm blowing the issue out of proportion.

Thanks in advance.....:)

JKL

Specializes in Trauma/ED.

We do give some cab vouchers but we also escort some off our campus by security. If they refuse to leave the campus after they are discharged and are loitering the police may be involved with threats of trespassing.

In my opinion anybody treated and released should not be in or around our hospital. If they are homeless there are shelters if they are high they need to be high at home and not around other "sick" patients.

We've had issues with patients needing cab vouchers frequently. It's normally the same patients and the ones who come by ems to boot. They abuse the system of course. I guess it happens everywhere and is a by-product of a learned behavior. It's a bummer, but what can you do?

It is sad not having hospital deal with this issue...they just pass it on to their front line workers(nurses)....our security at work is not the greatest, and they are quite old.

Specializes in Emergency & Trauma/Adult ICU.

The only times we put someone in a cab is if we have secured a bed for them at a women's shelter or in the event of really unusual extenuating circumstances. We make very judicious use of bus tickets too.

I completely agree that the patient's medical chart should be closed out once they are discharged. Anything that happens after that which needs to be documented needs to be communicated in some other format, such as incident report.

Specializes in ER/Trauma.

Mini rant:

I am so SICK and TIRED of docs promising patients cab vouchers.

"Oh don't worry. The nurses here will get you a cab voucher". Like it's a magic pill or something.

Unless you were incapacitated, how did it become the hospital's responsibility as to how you got home?

Cab vouchers are scarcer than hens teeth around here. On average, our ED gets about 3/month (and this is an ED that sees over 6000 patients a month!)

To all those who 'promise' cab vouchers to patients, please, please, please consult a nurse before opening your big mouth!!!

The End.

Specializes in Emergency Dept, ICU.

Our security has no problem kicking people out onto the street. And those who panhandle for rides and money in the parking lot too. Once Discharged off property you are too exit the property.

Sleeping is not allowed.

Specializes in ER, Med/Surg.

This is assuming you have cab vouchers...or cabs for that matter...or security! *I* was security in our ER when I was a unit clerk, just because I was the only guy (besides the docs, who all weighed about 100 pounds..hmm) in the department.

Thanks everyone.

No security here.... and we use cab vouchers judiciously, for special/extenuating circumstances (rare); this pt already had his chance at a very expensive voucher for cab ride home (d/t distance from the hospital) and it did nothing but enable the behavior. Totally abused. This is someone who in the past has gotten a ride home from the hospital and walked into the house and called 9-1-1 again for a free ride to another hospital. This particular case is so frustrating as I believe Risk Management has taken this to both local authorities and the court system to no avail.

As advised here, I will not chart on this pt post-discharge. Since my original post, I've been told to let the house supervisor handle this patient after discharge, so that's what i plan to do, and if I ever document anything, it will be that I have notified the supervisor of the patient's discharge and lack of means to leave the facility.

Thx!

JKL

Our ED too has this problem with many pts who abuse the system and never have a ride home. We give cab vouchers but only if all possiblities have been attempted. We tell them all that we no longer do this but we do give these out as quietly as possible. These pts quickly catch on to this as I'm sure you know. We have pts who will go to the ED just for something to do (kind of sad, really). We have the frequent flyers who have shown up to the ED for the same complaint 3 times in a 24 hr period! By this time the ED docs end up admitting them probably because they fear legal action. If they are harrassing others in the waiting room we have our security call the local police. The more times you can get it documented the better I think. Once these guys are discharged they are discharged. There is no reason we as nurses should be held responsible for them at that point. If anyone should be it should be the hospital for not coming up with an action plan for these instances. :banghead:

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