Where do patients go?

[NextGen]

I have been a nurse for 7 years, worked 5 in acute care and the last 2 in Acute Rehab. Patients are being discharged from acute care much sicker than they were 5 years ago.

The theory behind Acute Rehab is that patients are medically stable when they are admitted. So the unit is staffed for medically stable patients. That means the unit has 2 RNs only for 8 patients and when we get a PCA when we get a 9th patient.

The problem is that Acute Rehab is admitting more and more patients who are not medically stable but have been discharged from acute care. Our doctors are not medicine doctors, they are PM&R docs.

Acute care is like closing time at the bar "You don't have to go home, but you can't stay here".

In your state, where do patients go who still need medical management but are being discharged from acute care? Are they going to a facility that medically manages them?

Thanks.

[Glycerine82, LPN]

They come to me in sub acute short term. ?

[beekee]

And yesterday, in acute care, the nurse had 4 patients. Today, in subacute, the nurse has 15. Seems safe, doesn’t it?

[Here.I.Stand, BSN, RN]

Continuing to require treatment doesn’t = “unstable.”

[Glycerine82, LPN]

2 minutes ago, beekee said:

And yesterday, in acute care, the nurse had 4 patients. Today, in subacute, the nurse has 15. Seems safe, doesn’t it?

oh yes. I have 19 beds, usually i'm almost full if not full. Its scary AF, to be honest.

The biggest thing is making sure they are actually stable once we get them admitted. If they really are, its do-able but so often they are absolutely NOT stable and get sent back out within a few days. It's not unheard of to send folks back the same shift, even.

[VivaLasViejas, ASN, RN]

I've had to send patients back to the hospital before I even let them in the facility. I'm not kidding: one pt died just as he was being brought in, and another I greeted at the door only to take one look at him and tell the transport team to get him back to the hospital. It's unbelievable, the shape some people are in when they're discharged from the hospital. Treat 'em and street 'em. It's all about the almighty dollar for sure.

[Nurse SMS, MSN, RN]

LTACH when we can get them approved. Rehab when we can get them to accept the patient. SNF if it is known that neither rehab nor LTACH will cause any change in condition.

Doesn't your facility have to approve admissions before taking them? This is a two pronged problem. Yes, the hospital for discharging an unstable patient, but also your facility for accepting the patient. I had many patients who lingered inpatient for weeks because we could not find an alternative facility willing to take them on.

I agree with the above poster, that continuing to need intervention does not necessarily mean "unstable".

[Hoosier_RN, MSN]

On 1/3/2020 at 7:07 AM, Nurse SMS said:

LTACH when we can get them approved. Rehab when we can get them to accept the patient. SNF if it is known that neither rehab nor LTACH will cause any change in condition.

Doesn't your facility have to approve admissions before taking them? This is a two pronged problem. Yes, the hospital for discharging an unstable patient, but also your facility for accepting the patient. I had many patients who lingered inpatient for weeks because we could not find an alternative facility willing to take them on.

I agree with the above poster, that continuing to need intervention does not necessarily mean "unstable".

I used to do admissions for the rehab unit of a facility that I worked at. The lies that I have been told by hospital discharge planners/case managers, just to get them out of the hospital, is unreal. I've also done case management and know that the CMs can be under pressure to get the patient out the door. Glad that I don't deal with that racket anymore.

[CharleeFoxtrot, BSN, RN]

On 1/2/2020 at 6:32 PM, Here.I.Stand said:

Continuing to require treatment doesn’t = “unstable.”

When I worked rehab, I called patients on the cusp "stably unstable"

[VivaLasViejas, ASN, RN]

45 minutes ago, Hoosier_RN said:

I used to do admissions for the rehab unit of a facility that I worked at. The lies that I have been told by hospital discharge planners/case managers, just to get them out of the hospital, is unreal.

This is so true. I was in the same position, doing admissions for both SNF and long-term care, and so many discharge planners outright lied about the patient coming to us that I took everything with a very large grain of salt. There were a couple of D/C planners that I couldn't trust farther than I could throw them. But the decision to admit them, sight unseen, was above my pay grade so I had to play the cards I'd been dealt. The one bit of power I had was the ability to assess them literally on the doorstep if they looked bad, and if necessary, send them back to the hospital if their vital signs were unstable, they were having trouble breathing, or they were having severe pain that the pain meds they'd gotten before leaving the hospital didn't touch.

[JJBookman]

“In your state, where do patients go who still need medical management but are being discharged from acute care? Are they going to a facility that medically manages them?”

they are normally transferred to a skilled nursing facility or LTACH.

[Thanksforthedonuts, MSN, APRN]

8 hours ago, Hoosier_RN said:

I used to do admissions for the rehab unit of a facility that I worked at. The lies that I have been told by hospital discharge planners/case managers, just to get them out of the hospital, is unreal. I've also done case management and know that the CMs can be under pressure to get the patient out the door. Glad that I don't deal with that racket anymore.

OMG YES! I’m so glad I’m not the only one with the same opinion. Luckily I’m in a position where I can visit the patient in acute care to assess before admitting to our facility.

... many of the discharge planners and case managers don’t like me anymore ?. Ridiculous stuff they pull.