Why do some still sick pts get the boot, while needy not too sick ones stay too long?

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Specializes in LTC, Med/Surg, Peds, ICU, Tele.

Why is it that some people who've had major surgeries or other medical catastrophies, get rushed out of the hospital as if they are cars on a assemblyline? And other patients, with vague symptoms of abdominal pain, get to linger for days, milking the nursing staff for all they're worth?

I had a patient this weekend who was booted out too soon post CABG only to be returning in terrible shape and heading towards intubation. I had some other patients who were needy, demanding, non-compliant people who really need to live in LTC and they got to linger on forever and a day.

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Specializes in Hospice, Med/Surg, ICU, ER.

Follow the $$$$$

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That is a very good question. I wonder if it has anything to do with insurance.

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Specializes in Med Surg, Hospice.

I don't know, and I wish I did.. I've had a whole wing of them for the past 5 days that should have been outta there 10 days ago. And one train wreck that is way too sick for our floor....

Just.Go.Already.

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Specializes in Med/Surge, Private Duty Peds.

haven't been able to figure that out except it comes down to $$$$$.

i have taken care of pts that were too ill to go home yet they went anyways. had this one pt that stayed 4 weeks, every day it was a differentc/o; ha, migraine, abd pain, diarrhea, bllod in stool, it never stopped until the day the insurance stopped paying and guess what he went home, because if he stayed he would have to foot the bill.

i will probably catch a flame or 2 for this comment, but i notice that the non-complient renal pts, copd'ers, chf that are on the system, don't take their meds, don't follow the doc's orders are the main ones that want everything when they want it and yet complain if they had to wait an extra 15-30 min for prn pain meds, nausea meds, a soda, ice, or whatever. they complain to the suites who run the place, think they are at the hilton or some other hotel, saying they will never come back because the staff was rude, yet let a few days or hours sometimes go by and wow they show back up because. couldn't get to dialysis, ran out of bp meds, still smoking etc, etc, etc.

we have one more messed up health care system, yet can spend millions and billions of $$'s to run for president!

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Follow the $$$$$

:yeahthat:Plus some people know how to kick up a fuss when they are approached about discharge. One case in particular comes to mind for me. There was a young woman on my unit that was terminal with cancer(really quite a tragic case), she was WAY beyond any treatment modern medicine could provide. EVERY other patient I had with terminal cancer like this had been discharged to hospice, sometimes home or sometimes LTC. Anyway, she and her family were the most difficult, evil bunch I had ever came across. I managed to tiptoe around them without getting into trouble. I do believe all the docs, case managers and even the people at her insurance company gave her and them whatever they wanted just to stay on their good side. This included staying in the hospital for the most expensive care possible for a dying person. They had filed every kind of grievence against the hospital and everyone in it over and over again including charges of racial discrimination, abuse, neglect everything you can imagine. The state had been in to investigate the hospital, the county health department had been in to investigate the hospital. I do believe the docs and the insurance companies had every complaint filed against them with every goverment body that could be contacted. The end result was the family getting what they wanted. What they wanted was not to do any of her care themselves, they wanted someone else do all the dirty work and someone else pay for it.

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Specializes in LTC, Med/Surg, Peds, ICU, Tele.

Our healthcare system doesn't make people very accountable. It seems to reward non-compliance with a hospital bed, call light, cable TV, pain meds, and maid service.

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Sorry to tell you this but it happens in the Canadian healthcare system as well.

I know of 15 beds blocked by people like you've described. The patients are more than capable of going home but they sound pathetic when the doctors do rounds or the discharge co-ordinator stops by. "I feel weak when I stand for too long", "I don't feel strong enought to make meals", the list goes on.

Meals on wheels -- oh wait, they'd have to pay for that. Homecare can do their dressing changes but then they'd have to be home for the nurses visit.

No, far easier to lie in a bed costing over $4K/day, nagging staff who have far sicker people to care for.

We send postpartum patients home within 24 hours in most cases, sections in 72 hours and we can keep a lap choli who is 85yo for three weeks? Get a grip discharge planners. The 85yo has been dumped by the family (if getting difficult to deal with or is extremely manipulative). Most women would benefit from an extra day postpartum. Just to get some sleep.

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haven't been able to figure that out except it comes down to $$$$$.

i have taken care of pts that were too ill to go home yet they went anyways. had this one pt that stayed 4 weeks, every day it was a differentc/o; ha, migraine, abd pain, diarrhea, bllod in stool, it never stopped until the day the insurance stopped paying and guess what he went home, because if he stayed he would have to foot the bill.

i will probably catch a flame or 2 for this comment, but i notice that the non-complient renal pts, copd'ers, chf that are on the system, don't take their meds, don't follow the doc's orders are the main ones that want everything when they want it and yet complain if they had to wait an extra 15-30 min for prn pain meds, nausea meds, a soda, ice, or whatever. they complain to the suites who run the place, think they are at the hilton or some other hotel, saying they will never come back because the staff was rude, yet let a few days or hours sometimes go by and wow they show back up because. couldn't get to dialysis, ran out of bp meds, still smoking etc, etc, etc.

we have one more messed up health care system, yet can spend millions and billions of $$'s to run for president!

these are the people who think that they are entitled, that society "owes" them. they are the ones that need boundaries, and to be held responsible for their attitude. (when they say they'll never come back, the nurses ought to tell them "really? do you promise? i would like that in writing, pretty please".)

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:lol2: (When they say they'll never come back, the nurses ought to tell them "Really? Do you promise? I would like that in writing, pretty please".)
boy that would be great if we could do it but the next day we would be reading one of those "horrible nurse" editorials in the paper.
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boy that would be great if we could do it but the next day we would be reading one of those "horrible nurse" editorials in the paper.

It's too bad nurses can't write horrible pt. editorials in the paper.

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It's too bad nurses can't write horrible pt. editorials in the paper.

Thanks you make me laugh and that is a good thing.

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