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.
I got chewed out by the nurse manager once for not getting a bed emptied out stat. I explained that the pt had to wait til her husband got off work and came for her, which would be about 9. But we needed the bed now, at 4. I asked the manager what I should do and she got all pissed at me.
Specializes in ED, ICU, MS/MT, PCU, CM, House Sup, Frontline mgr.
This is why I am going to Nursing School. I am very business minded and business oriented and thus I am going to be an Executive in Health Care someday. However, I do not want to be anything like the VP in the OP's post! :uhoh21:
I do not know how to get around this situation other then to do as others have suggested. I had to work under a similar situation working as a Social Worker for a greedy organization (they made lots of money off the poor). I had a VERY good relationship with the Psychiatrist and managed to have discharge orders correspond with the convenience of patient's families. The docs and I did not let the managers or UMR know anything other then the discharge time and date. If they needed reasons, we had the documentation to back it up. It was always in the best interest of the patient and families. Good luck.
Having just taken a test on "documentation", the standard of care with D/C orders states that you need to write the date and time of the discharge and the person who picked the patient up. Leaving the patient down in the coffee shop unattended is not going to afford you the opportunity to chart time and person d/c'd to...
Do you have Docs you can work with? Maybe just have the order written.. "May D/C when husband (or whoever) is available to pick up". The Drs probably don't like this liability either.
At my facility we have a slightly different problem in regards to discharges. What is happening is that the doctors will tell the patient bright and early in the morning (sometime between 5am-7am) that they a discharged. The patient, who no doubt can't wait to get out of here, calls their family/friend to arrange to pick them up. The problem: the doctors not writing their discharge orders, or the completing their documentation (providing scripts, instructions for F/U, etc) so that the nurse's CAN discharge these patients. We have the problem of irritated/irate patients and family members ready to go but not able to, and dealing with docs who repeatedly tell us they "will be there soon" with each phone call we make on the patient's behalf.
In regards to the situation Tweetie described, our facility has what is known as a discharge lounge. This is an area we can send discharged patients to until their ride arrives. It is staffed with nurses who will provide care (including documentation) for these patients. This frees up beds on the units.
The patient refusal is a good idea too.
I'm recalling an old thread about a patient refusing to be discharged for a year. :lol2:
They better look at it like a good customer service/quality of care issue. And letting a pt who may have pain needs sit in a lobby for hours waiting on a ride home is neither. Maybe the marketing director could assist this VP to realize what a bad community image this presents.
i spent a 24 hours in an er because the rooms upstairs were not free due to md not making rounds or because patient was not ready to leave
however there was no idea on the part of the hosp to kick someone out the door to accomodate me...most people are anxious to return home some think of it as returning to hell
what the nurse can do..write a letter of complaint, have fellow nurses sign with you,, that you have the interest of the patients upppermost in your decision [advise patients that they do have the right to refuse to vacate room until proper transportation can be provided [suggest the idea of another post that a discharge room that could be utilized while the housekeepers are preparing the room for next pt [try and give family members of pending discharge so that they could make proper arrangement
[have someone talk to doctors about the problem, frequently they have no clue as to the day to day problems of the hospital...ie the pts family on learning of next days discharge may ask the md if they can pick up after work and of course doctor will smile and boom out 'that will be fine anytime is ok'
advising pts before hand that after time they will be charged for an additional day
We have a discharge lounge that pt's can be taken to if they don't have a ride coming in the next hour or so. It is staffed by a Nurse Tech. It has TV, bathroom and snacks. The pt does have to be alert and more or less ambulatory (could be in a wheelchair) Several Doc's who come early have been writting "discharge after breakfast". Gee, sometimes breakfast is about 10:00 getting up to the floor! One problem is that we can't give any medications,ect after a pt 's discharge is written. Once discharged we are not covered to give meds. So there is not much reason for some pt's to try to stay longer to get pain shots,ect. They generally come up with someone they can call to come get them. If we are on "Full House" mode the ER can send the pt up to the floor where they stay on stretcher in the hall until the room is cleaned. I guess we have more room the the hall than ER does.
We also have hall beds for use durning a "Full House" I think we have only had ours set up and used acouple times and we knew a discharge was coming up so the hall pt could be moved. Some Dr's will write give am medications ,breakfast and thendischarge. Seems like most of pt's want to have all their meds before they leave and we can't give them if dc is alreay written. I tell them its cheaper to take them when they get home even if it is later in the day than they generally take them.
Someone from anesthesia told us today that the hospital they used to work at had rules that docs had to have the pt's ready for d/c by 10am. rounds had to be done early, and if hte pt was going to be d/c'd, all paperwork, rx's had to be written and ready by 10am or the doctor would be penalized and fined! (that sounded a little bogus)
10am is not a good time-right after med pass, etc.
We currently aren't making anyone wait in lobby. They are waiting in their room until their ride is there, no matter how long.
Good luck.
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:lol2:
Gabie Baby
168 Posts
I got chewed out by the nurse manager once for not getting a bed emptied out stat. I explained that the pt had to wait til her husband got off work and came for her, which would be about 9. But we needed the bed now, at 4. I asked the manager what I should do and she got all pissed at me.