Why does it takes so long to get released from the hospital after doctor's ok?
 

I am waiting to pick up a friend at the Leesburg Hospital. It could be late this afternoon before he will be coming home. This recently happened to me and I don't understand why. In my friends case, his cardiac physician told him at 8AM this morning he could go home. He must now wait until the Hospital doctor, a doctor he has never seen and doesn't even know, signs papers for him to be released. In my case, my urologist signed release papers at 7 AM for me to be released. The "Hospital Doctor" who had nothing to do with my three day stay in the Leesburg Hospital, did not come around until 5 PM that afternoon to sign the release papers. I found this to be very stressful and probably could have been handled differently. Why ??????

Money. An extra day stay at $$$$$.

If I was in that situation, I would tell the nurse station to get the doctor up to my room within a reasonable time (maybe 1 or 2 hours) to sign the discharge papers or I would be calling the hospital administrator.

our hospital the problem was that the doctor would be making rounds early but seeing several patients. many of them were told they were being discharged. the doctor, however, doesn't actually write the orders until after he's seen all his patients, sometimes hours later. so what was told at 7am might not be entered until much later. multiply that by many doctors and the discharges add up and come all at once. regulations require certain things to be done and it can be a mad house for staff and patients don't understand.

If the hospital was paid based on how quickly they discharged you, they would have you on your way ten minutes after your doctor released you.

Just out of curiosity, is there a problem with getting up and leaving when the first doctor tells you that you can go home? I know you would be leaving against medical advice... but technically, you're not.
I did it one time years ago in another state. Have things changed and they have some way to keep you from leaving?

In my case last year, my doctor said I could go home at 10AM. But the Villages Regional Hospital doctor (The Hospitalist) was down at Leesburg discharging patients. He is the hospitalist for both hospitals. He didn't get up to the Villages to sign the discharge orders until the afternoon, therefore I ended up having to wait until 5:30 PM to go home.

There is a possibility that the insurance will not pay if you are not discharged properly

If your admitting/attending physician has signed your discharge papers you are free to leave. If you have been under the care of the Hospitalist then he will need to sign the discharge papers.

If you have questions ask your nurse. If she doesn't know, ask to speak to the nursing supervisor/director on duty.

If you truly have not been seen by the Hospitalist and are billed for care, complain to the hospital. Then notify your insurance company.

On my recent stay, I was told by the charge nurse that I did not wait until the "Hospital Doctor" signed the release papers, my insurance might not pay.

This becomes very stressful for the patient and certainly doesn't help with his recovery. In my original post I spoke of my friend having to wait for a doctor that he has never received care from to sign the release papers. I just received a call from him, he is STILL waiting for the Hospital doctor to do his 30 second signing of the papers. Perhaps, I will never understand why this outrageous procedure is followed at our local hospitals.:cus:

This gets more goofy by the hour. I now find out that this "Hospital Doctor" that a patient has never had services from, perhaps has never seen, will bill the patient for his services, whatever that might be.. My friend is still waiting and will soon have been waiting eight hours.

As an R.N. case manager who has a small role with discharge planning, often times delays have to do with awaiting lab or other test results. The doses of medications that a patient will be discharged on are often determined by lab results for example the anticoagulant medication Coumadin is determined by the PT/INR result. Also getting x-ray and CT scan readings on day of discharge can cause major delays. Most hospitals now electronically transmit x-rays to radiologists all over the world and have to wait for a radiologist in Australia for example to read the films and transmit back the results. Some attending physicians will write discharge orders in advance but will include pending a particular lab or test result which requires the discharging physician/hospitalist to review the results and make any necessary order changes.

Believe me, the hospital staff dislikes these discharge delays as much as the patient because more often than not there is a patient in the ED who is in very much in need of that bed.

That is what happens when insurance companies make all the rules and not the medical professionals.

I am a RN and find it crazy that the Hospitalist is making the discharge decision. The patient was under his care simply due to being admitted during the Hospitalist's shift. There is no way he/she can be realistically be on top of all those patients. Very poor system.

Yes, call the House Supervisor. That is the RN in charge of everything that happens in the hospital 24/7. Because this is a weekend there will be no Hospital administrater sitting behind a desk somewhere. the House Super is where you need to start.

In my case after triple bypass surgery the hospital doctor wouldn't release me because he said my sodium was too low but my the doctor that did the surgery came in and said he's releasing me. I asked why and he said that the results of the last sodium test had to be wrong since I would have had to urinate many gallons in the past few hours. He said that was impossible and he was right.

Sorry, but the doctors I and my friend were not an attending physicians. I had no tests and my only prescription was already written by my primary doctor. And it was true that my nurse was not a part of the delay. I do understand your reasoning and and appreciate your comments.

I would be interested in what the hospitalist charges for his discharge duties. Check your bills. If you didn't see the hospitalist I would question the charge. It sounds like they need more than one hospitalist on duty each day. Especially during high season. Covering two campuses sounds ridiculous. Just think about all those poor souls waiting in the ER for a bed....

Hehe! When we lived about 2 miles from the hospital down in Hollywood my hubby was in there once for chest pains, which turned out to be nothing thank goodness. So I was at work when he was released. He walked home in his hospital robe. Geez! I was amazed that he wasn't picked up by the mental health people. We still have that robe.

It has happened twice with my Mom -- here in Michigan.

About a year and a half ago, Mom (89 at the time) was told she could go home at 1 in the afternoon. After several hours, we asked the RN what the delay was. She said the hospitalist was busy and we had saw him walking down the hall many times during the day. The hospitalist apologized profusely and told us there was a miscommunication! Mom was discharged at 11:50 PM -- that's right, 10 minutes to midnight! The next day the hospital called about her hospital stay and she told them what time she was released! She never received a bill for that hospital stay and she was in ICU 4 days!

In December, Mom was released six hours after she was told she could go home. We were told the hospitalist would see all the patients on his rounds and then sign the paperwork. We found out later that he was discharging a lot of patients because it was New Year's Eve. We wondered if he wanted to discharge them before the new calendar year for insurance purposes.

I hope your friend eventually made it home safe and sound. As difficult as discharge delays are for patients, believe me it is the lesser of two evils with the greater evil being discharged too soon. On more than one occasion I have had patients show up in the clinic that were discharged from the hospital a few days prior asking me to take out the IV that was still in their arm!!!

Is this Hospitalist doctor position something fairly new, just down here, or have they always existed. Never heard of it before being down here.

They are all over the country, and have been for 10+ years. Some are employees of insurance companies, some are independent contractors, some are hospital employees.

I did that once. I told them I was leaving and they said that I would be leaving against medical advice. I was then told that I had to sign some papers absolving them of responsibility.

I told them that I'm not signing anything and walked out. A nurse tried to stop me and I asked if she'd like to be reported for kidnapping. She got out of my way and I left. Never heard from them again.

He finally did make it home, a bit stressed out but home at last. My original point was to the effect that your primary doctor, the one that was in charge of your care, released you to go home. You now find that a doctor whom you have never seen or was never involved in your care must sign your release papers. What is the purpose of this "hospital doctor" and why is he now in charge of you going home. I would risk a fortune betting that the so called hospital doctor has never reversed the decision of a person's primary doctor. And again. thanks for asking about my friend.

The new ACA-related penalty reductions in Medicare/Medicaid/Insurance payments to hospitals, due to re-admission of the patient within 30 days is probably part of why they have to do more CYA when releasing a patient.

If they have to come back due to relapse or complication within the 30 days, payments are cut to thousands of hospitals already losing money on Medicare payments that are less than the cost of providing the services, and private insurers pay what Medicare pays:

…..Under the new fines, three-quarters of hospitals that are subject to the Hospital Readmissions Reduction Program are being penalized. That means that from Oct. 1 through next Sept. 30, they will receive lower payments for every Medicare patient stay — not just for those patients who are readmitted. Over the course of the year, the fines will total about $428 million, Medicare estimates.

...The fines are based on readmissions from July 2010 through June 2013.

In New Jersey, every hospital but one will lose money this year. So will a majority of hospitals in 28 other states, including California, Florida, Georgia, Illinois, Massachusetts, New York, Ohio, Pennsylvania, Tennessee and Texas, as well as the District of Columbia, according to a Kaiser Health News analysis of the penalties.

Medicare Fines 2,610 Hospitals In Third Round Of Readmission Penalties | Kaiser Health News

Then read how these and other penalties are 4 times greater than the Quality Bonuses most hospitals are earning, with the new rules for that:

Medicare is giving bonuses to a majority of hospitals that it graded on quality, but many of those rewards will be wiped out by penalties the government has issued for other shortcomings, federal data show.

As required by the 2010 health law, the government is taking performance into account when paying hospitals, one of the biggest changes in Medicare’s 50-year-history. This year 1,700 hospitals – 55 percent of those graded – earned higher payments for providing comparatively good care in the federal government’s most comprehensive review of quality. The government measured criteria such as patient satisfaction, lower death rates and how much patients cost Medicare. This incentive program, known as value-based purchasing, led to penalties for 1,360 hospitals.

However, fewer than 800 of the 1,700 hospitals that earned bonuses from this one program will actually receive extra money, according to a Kaiser Health News analysis. That’s because the others are being penalized through two other Medicare quality programs: one punishes hospitals for having too many patients readmitted for follow-up care and the other lowers payments to hospitals where too many patients developed infections during their stays or got hurt in other ways….

1,700 Hospitals Win Quality Bonuses From Medicare, But Most Will Never Collect | Kaiser Health News

Maybe some of this will be instructive as to why doctors and nurses doing actual patient care and interaction is far down the list of priorities amongst all the things they have to do.

They're bound, gagged and handcuffed to a computer screen by the growing bureaucracy and the patient comes last!

Why does it takes so long to get released from the hospital after doctor's ok?
 

Sunny - I agree with much of what you say. But, most hospitals are not losing money taking care of Medicare patients. Medicaid, yes; but not Medicare unless they are poorly run.

Ok. Is this incorrect, quoted above in red?

"In New Jersey, every hospital but one will lose money this year. So will a majority of hospitals in 28 other states, including California, Florida, Georgia, Illinois, Massachusetts, New York, Ohio, Pennsylvania, Tennessee and Texas, as well as the District of Columbia, according to a Kaiser Health News analysis of the penalties."

Also: In your hospital administration experience, are the added government-mandated rules conducive to patient care and wellness, or a hindrance?

I try my best to stay out of hospitals. I have too say though that sometimes it takes some working to get out of county in a timely fashion.

Well let's take a look at Florida. There are at least 4 major for-profit chains in FL: UHS, HCA, CHS, and TENET. do you think they would be operating here if they could not make money on Medicare patients?! Each of their stock prices has risen considerably over the last 3 years.

As for the additional mandates, I believe they are a hindrance to an appropriate physician patient relationship and represent too much government intrusion into that relationship. They are also, in many cases, unrelated to patient care. IMHO

UHS 3 year price chart:
http://www.marketwatch.com/kaavio.We...579&mocktick=1

Think
 

I seem to always be on the other side of the coin in discussions, but I try to look at all aspects of subjects.

I have talked about this with our doctors and have noticed a change in how they talk about it to their patients. I have also put it on every hospital follow-up survey. Just because Doctor A tells you that he is discharging you, does not translate to right away for many reasons. Many of them now say, "You can go home today, but I cannot tell you a time so just sit back and relax in the meantime."

I will try and list some of the reasons I know about:

He/she often has many patients on the same floor and must complete paperwork (write orders for all, including the decision to release along with writing scripts, etc.). Seeing the patients includes answering their questions, reviewing care plans with them, explaining why they are perhaps ordering additional tests, etc. This takes time and they are not going to sign off on everything until all of this has been done and they have gone over everything with the staff. They do not do all of this one patient at a time.

Sometimes, you have to be seen by all your doctors (specialist(s), primary) and then they have to sign off before the hospital doctor can. Not all doctors can/do make rounds at the same time. Some do rounds after their surgeries have been completed and/or emergencies addressed.

Nurses cannot tell Patient B that they will have to wait for their meds or care because Patient A has been told he/she can go home today and will be upset if they don't get IV's out, discharge papers signed by them, etc., right away. RN's are the ones that have to do all of this and are the only ones allowed to dispense meds or do discharges.

Last, but not least, everything comes to a screeching halt if one of the patients gets into a life-threatening situation and all resources are directed to that patient. I'm sure someone was waiting impatiently to go home when my husband went into cardiac arrest in 2013. Because of the skills and teamwork that morning, I still have him today.

I guess all I am trying to say is that all these people have a job to do and it absolutely has to be done correctly; maybe not yours, but someone's life might be at stake. Nurses and doctors are dedicated people; otherwise they would have chosen much easier professions for themselves. Any business, including hospitals and doctors, is about money. No money equals no hospital or any other business. All of us not in business worked for money....nothing wrong with that, either. The fact that these people have to make life and death decisions everyday is priceless. I cannot imagine having the burden of having to tell someone that their loved one is going to die no matter what or has died, despite all efforts to the contrary nor can I imagine having a job that someone's life depends on how I do that job.

Please try a little more understanding and patience. Hospitals are miserable necessities and not 5-star hotels as some patients seem to think by the way they treat the nursing staff when they are there. They cannot leave just because their shift ended at 6:00 or whatever. If they are in the middle of some patient's care, they can't just say, "Sorry, my day is done.", but continue that care until it is finished. Sometimes a new patient is admitted 45 minutes prior to their shift end and they have to stay until everything is set up with that patient. There is much work behind the scenes that many people never know about.

Ok it must be different depending on the hospital and or insurance. Hubby was in a hospital in Bellevue Wa for a stint. Kept him or an extra day to make sure no blood clots. The surgeon and his personal doctor who both member/owner doctors of the hospital signed off after morning rounds and home he went within an hour. Now when I was in my doctor signed off on a Sunday and it took three hours for the paperwork same hospital, but it was a weekend. However neither of us was on Medicare at the time.

A couple of years ago, my husband was admitted to The Villages hospital four different times. Each time his cardiologist said he could go home, it took as long as 8 hours for the admitting doctor (from the ER) to sign the discharge papers. In the meantime, I am sure, there were other patients in the ER waiting for a room. There is definitely something wrong with the process. Hopefully, by now, they have improved.

Dillywho, as a retired RN, I can't tell you how much I appreciate your post! You nailed it!

Two of the smartest people in the universe, and both thankfully friends.

bump. Great post Dilly. NO, WONDERFUL post Dilly.

Just a question - are they digital? When I went in at home they had gone digital - A screen pulls up the records the doc signs the screen and the system updates a discharge person comes by you sign the screen and off you go. Now it took them almost two years to convert but now it is up and running it seems to work great.

It's all about money and legal issues!

That a Corvette?

I am bumping this again and hoping the OP will read it and respond.