Overloaded hospitals, 10 admission, 12 hour discharge
 

I accept the idea that our hospitals and nursing staff are taxed to their limit. I recently had am ambulance transport to our local hospital and using an ambulance was certainly warranted. I was placed on a gurney type bed in the ER hallway, I did receive care but spent 10 hours in that hallway never be admitted to a ER room.
My purpose with this post is to say we know of the long admission process thru the ER's. But what sense is there in it taking 12 hours getting discharged from a hospital ??? Several days later and another kidney stone attack landed me in the Leesburg hospital. Eight hours anain thru the ER process, four days in the hospital. Kidney stone removed, early in evening on the fourth day, both doctors tell me , I will go home tomorrow. Early the next morning (8:AM) The IV, etc are removed. I WAS NOT DISCHARGED UNTIL 5:30 PM. There always seemed to be another thing that need to be done, final release from the DR. Meds and that sort of stuff. It in unbelieveable that the discharge process took 9 and a half hours !!!! Basicallty, I layed in that hospital bed and watched TV for an entire day.

Warren. I am hoping you are feeling better. Our son in law had kidney stones and the pain was TERRIBLE. I feel so bad for you. It was in Cincinnati and he went through the same thing waiting to be admitted but they did give him pain relief. I hope you got pain relief.

I will tell you this. Our daughter has had many hospitalizations over many years and it always seemed to take all day to get the release signed to go home. There were many final things to check and the doctor had to sign you out.

And of course that kidney stone had to arrive during the busy season.

One of the problems to getting discharged..and it is absolutely maddening for nurses & other hospital staff is getting YOUR doctor to discharge you. The doc's gotta sign off, and many, many times the staff is just cooling their heels waiting to get the doc to sign you out. That doesn't mean the doc is out goofing off or playing golf while you're waiting. He may be seeing regular patients, he may have been sidetracked by an emergency while doing his rounds and so forth. But without the OK from your doc or the staff Hospitalist-MD, you're not going anywhere.

Since TVRH has a chronic shortage of needed beds, that causes all the other things to slow down, which then adds to the ER waits. It's a vicious circle. The staff wants you OUT! And I don't mean that in a mean way..they need your empty bed. At TVRH they are essentially "hot sheeting" those beds. As soon as somebody is discharged, and fresh linen can be put on the bed and the room quickly cleaned up, they've got somebody new to put into that bed.

Basic rule of thumb if you're headed to the ER..Plan on being there at least 12-15 hours. I'm talking from wait time to discharge. It can be a lot longer, but I hear funny stories about people coming by with very unrealistic ideas about how long their wait is going to be. You can't stop by at 8am and hope to make your 12noon tee time. Not gonna happen. Really...if you're going to go to the ER..You can plan on being there ALL DAY, and by all day it's not unrealistic for that to mean 24 hours.

But..no matter how long you've waited..Be kind & don't take out your frustration on the nurses, aides & doctors. They are running their tush off for you!

I am sure with the Affordable Health Care Act kicking in soon, that sort of emergency care waiting problem will be much improved.

Yeah................right......................... ..

Food for thought:

Government and health insurance intrusion penalizes efficient doctors

Keep one thought in mind....as the new health care laws take more effect, and millions more enter the EXISTING health care system.....

What we have today is THE BEST IT WILL EVER be for the foreseeable future.

So like it or not enjoy what we currently have while it lasts!!

btk

Maybe if a few people just walked out when the iv's are pulled, they'd find a way to streamline the process.

Exactly what I was thinking. Give them 1/2 hour to get squared away, get dressed and leave. They can't physically restrain you. They can squawk all they want. If you need meds, tell them to call the pharmacy, and you will pick them up. :wave:

pick a hospital in any city and you at times will find the same...of course if its a child with a hot appy its even a harder to sit in that hall

Bobnbev
Be careful when suggesting leaving before the paperwork is complete. What if insurance doesn't pay the hospital because you left. I forget the term the hospital uses on the chart but it flags it. I wish they would improve the process. Hospital has Electronic Medical Records. The attending could complete the discharge orders he does not need to put "eyes on you" before discharge. The nurses can review the information. There seems to be a lot of finger pointing within the hospital. Processes can be changed to meet the needs of the patients, the insurance, and the hospital's policy makers. Maybe the hospital should start a campaigner, " Get in, Get out, Get Better".

If you leave without being formally discharged (The technical term is Against Medical Advice) Your insurance absolutely WILL NOT PAY ONE SINGLE DIME OF YOUR BILL. Yep..that's right, you'll be stuck with 100% of the cost. It might make you feel good to just stalk out, but you'll feel plenty sick when you get stuck with the full cost of your stay just because you wanted to prove a point.

It would seem the bottleneck in the ER is caused by the lengthy discharge. During the times I have been in a hospital (up north) the doctor would see you during his/her morning rounds and you would be discharged within an hour or less.

Just speculation but if you stay past noon maybe the hospital gets to charge for another day.

It doesn't quite work that way..the insurance companies won't pay for that, plus TVRH needs the beds too badly to be attempting to play that game.

You are certainly correct that they NEED the beds, but going about releasing the beds is another matter. I was at urgent care recently. The Dr. wanted me to get a particular test that had to be done in the hospital. He told me to walk across the street to the hospital and he would send the orders over for the test. I walked over, they admitted me into a bed in the emergency room....walking past MANY sick and injured folks on gurneys in the hall way. I explained that I do NOT need a bed...only a test. they admitted me anyway. After blood work and a couple hours wait, they took me for the test....then back to the room that I didn't need. They kept me waiting in the room for another 4 hours while I waited for results, then a Dr to release me...all the while taking up a bed (really the room, I never got in the bed). On my way out I still saw many folks in the hall that needed a room. Two in particular had very bloody heads. Didnt have any idea why this incident happened this way....I was not sick, nor in an emergency situation...Is it possible that they saw that I had private insurance and not Medicare??? I hope thats not the case, but I did feel ridiculous taking the room away from those that needed it.

A number of years ago I was waiting to be discharged and finally gave up waiting. I walked out; the next day I got a phone call wondering where I was. It took them that long to figure out that I was no longer in the hospital.

There are a great many rules & regulations that govern hospital operations, treatments and so forth. It's an absolute gobbledegook of federal & state silliness. I certainly don't know about your personal situation, and I'm not going to pretend to know much about all the rules & regs. However with that said, there is most likely a reason that you were given that room that had something to do with procedures that some agency requires the hosptial to do in your particular case. A lot of times none of it makes sense, but you would be surprised just how many picky rules hospitals have to follow to get paid. It may not make any sense to you, and it most likely makes no sense to the doctor or hospital, but they have to follow these rules. Very likely that was the reason that you were assigned a room in the ER.

Long Discharge
 

I might add a few things, Both doctors had conceded that I would be discharged the next day. The nurse in charge told me that I would have to wait until the hospital doctor signed the discharge papers. This was a "hospital" doctor I did not know, had not seen until that evening and had not hired. It was his signature I needed. After 7 hours I asked the nurse when this doctor was expected, she stated she did not know. I asked her to get in touch with this doctor, she said she couldn't do that. This was the point where I told her in one hour if this discharge doctor had not shown up, I would sign myself out. Soon she came to the room and said the doctor would appear in an hour or so. And he did. As far as I know this doctor was at home watching Tiger win the golf tournament while I fumed. Two more hours for the nurse to prepare two papers for my signature before I could leave. Hospitals like this simply must do better !!!!!

Getting out of the hospital is not an easy thing to do.
 

Warren, what happened to you is a normal happening and it happens in the best hospitals in this country including The Cleveland Clinic.


The doctor who probably signed you out is called a "hospitalist", someone who is assigned your case to over look for your admitting doctor.

He MAY have been watching Tiger at home or he may have been administering life saving care to someone. Your nurse probably wasn't doing her nails either.

The important thing to keep in mind is that they did finally let you out and fixed your Kidney stone difficulty and the terrible pain from it..... and all is better than it was.

I would like to add that your doctor is not a machine and requires sleep, food & time in the toilet just as you do. No doctor is on duty 24/7. Often times there is another doctor who belongs within your doctor's practice who is "covering" your doctor. This is very standard practice. Doctors cover each other so that they can have a weekend off..see their family occasionally, go to church from time to time and so on. The nurse who told you that "she couldn't contact your doctor" was not trying to give you a hard time. They cannot simply dial up your doctor because you wish it. They must go through their charge nurse with that request. If your doctor is being "covered" then a phone call to the covering doctor will be made, and he/she must be located. G-Person is right..you were most likely signed out by a hospitalist acting under orders from your doctor or the covering doctor. Nurses cannot simply make up your discharge papers out of thin air ahead of time. They CANNOT write up the paperwork until whatever doctor officially discharges you actually does so. They then have to take down whatever orders the doctor issues and then do all of the paperwork which is quite lengthy. And...if they make a mistake on the orders it's on THEIR license & could cost them their jobs!

BTW..here's a helpful hint..Do Not bark at your nurse and order them to do things as if they were your servant. She/he is not. They are highly trained professionals and they deserve RESPECT at all times. They put up with more than enough BS in their 12 hour shifts and if you start barking, they start going deaf. Treat them kindly & with respect and you will get things to happen much..MUCH faster!

the problem
 

I appreciate all the words encouraging my understanding of Doctors and Nurses and their tremendous responsibilities. BUT and this is a big BUT, when a person has had a hospital stay, they are usually very stressed already. To sit in a hospital room wearing their street clothing for 10 maybe 12 hours for a doctor's signature on a discharge paper brings that stress to an unbelievable level. Somehow, someway this simply should not happen. Being well and leaving a hospital should be a celebration, not a horrible experience. A patient is entitled to a major degree, an explanation what is to take place.

I agree. "To sit in a hospital room wearing their street clothing for 10 maybe 12 hours for a doctor's signature on a discharge paper" makes a patient feel like they are nothing more than a brainless, inanimate object.....like a slab of meat.

Respect has to go both ways.