You're Discharged....GET OUT NOW!

[Tweety, BSN, RN]

Our VP of Nursing (not a nurse) wants to keep the ER open at all costs. We never close but often critical care beds are in such short supply with the ER holding many critical care patients they have no choice but to go on divert.

Many time the floors are full, and there are critical care patients who have been downgraded waiting for beds.

So the VP says we are to encourage d/c'd patients to get rides home as soon as they are discharged. This is not always possible because the patients on my unit are flown in from hours away.

The solution is to buy them a cup of coffee at the coffee shop and make them wait in the lobby. We're doing so much remodeling and so short of nurses we our "admit/discharge" holding area had to close.

Also most of my patients are discharged on pain medicines and take them regularly for their injuries. So I'm to discharge a guy on q4h Percocets, two broken legs to the lobby to wait until his ride two hours away gets here? Or worse someone d/c'd in the AM whose spouse works and can't get there until many hours later.

I am going to find some way to be non-compliant with this.

My question is: is this a common practice. Anyone else doing this.

[wooh, BSN, RN]

I think maybe some planning ahead with the MDs needs to be done. When possible, the MDs need to decide the day before when the pt will be d/c'ed so they can call family/friends to make arrangements for rides BEFORE the d/c orders are on the chart.

What does risk management say about this? Visitor trips over crutches of a d/c'ed pt waiting for a ride, that lawsuit money could start your building expansion fund!

[imenid37]

I guess if your greedy employer wants to make all of these renovations, then they will have to eat the cost while they are short on space. No way in HE!! would I sit in the lobby w/ 2 broken legs and wait all day for a ride. Maybe some pts. need to write some letters or call a tv station. There are tons of attorneys down there in FL, I am betting an upset pt. will contact one soon when they get that kind of care.:angryfire

[gauge14iv, MSN, APRN, NP]

The patient CAN refuse to leave until his ride arrives. Geeeee.... I wonder how he would know he could refuse? Hmmmm...

[KikiRN06]

Where I work we are not allowed to discharge patients until their ride arrives, I have had patients request to be discharged and allowed to wait in the waiting room and was told that the hospital would be liable if anything should happen while the patient was waiting.

[gauge14iv, MSN, APRN, NP]

And what about that patient on those q 4 hour pain meds with two broken legs who hasnt had his scrips filled and who wont be able to fill them until he is on his way home with his ride? Is supposed to sit somewhere in pain all day?

Sounds like a discussion with risk management AND this persons supervisor might be in order, as well as your nursing CNO.

[UM Review RN, ASN, RN]

The patient CAN refuse to leave until his ride arrives. Geeeee.... I wonder how he would know he could refuse? Hmmmm...

I think that's true, and we've actually had MDs D/C the D/C orders till patient had that ride.

Clever thinking, gauge!

Tweety, your VP needs some brain food: :trout:

[Marie_LPN, RN, LPN, RN]

Needs to have a brain to feed it first.

I wonder how this VP would react if this were his/her mother that got treated like this.

[babiesX2]

And what about that patient on those q 4 hour pain meds with two broken legs who hasnt had his scrips filled and who wont be able to fill them until he is on his way home with his ride? Is supposed to sit somewhere in pain all day?

Sounds like a discussion with risk management AND this persons supervisor might be in order, as well as your nursing CNO.

My hospital is so bankrupt, management recently conducted a round of "lay-offs." It was determined that our Risk Manager was unnecessary. :trout: But, that is another thread.

I have always been told my assigned patients are my responsibility until they have left hospital property.

[PANurseRN1]

I think there are some clear liability issues here. As long as the pt. is on hospital property, the hospital is technically responsible for the pt. If anything happened to one of those pts. in the lobby, the hospital could be staring down the barrel of a huge lawsuit.

You know, I think an anonymous complaint to the DOH would be in order.

[Tweety, BSN, RN]

Hmmmm..........I never thought to check with Risk Management.

The patient refusal is a good idea too.

[ICRN2008, BSN, RN]

I don't agree with discharging patients and just letting them sit in the lobby. I believe that all patients should be cared for until they leave the building.

However, I would like to play devil's advocate for a moment. If your loved one was being discharged from the hospital, why would you let them sit there all day and wait for you? I would do my very best to get off of work or make arrangements for someone to pick them up. When my grandparents and great-uncles were in the hospital, my mother did all that she could within her power to make sure they were properly cared for, including taking them to appointments and picking them up from the hospital. (She used her lunch hour and vacation time for this). I would hope that my family members would do the same for me.

I understand that for some people taking off of work is impossible. However, I have also heard of parents (at the Children's Hospital) and caregivers of elderly patients using the hospital as a glorified babysitting service because they have "important stuff to do" (read: run errands, get nails done, go shopping).

I guess what I'm saying is that I think the patient and family have some level of responsibility for making arrangements to leave in a timely manner after discharge orders come through. Hospital care is extremely expensive and resources are scarce in some cases, so it is not fair to everyone else to tie up that bed unnecessarily.