[dbussone]

Originally Posted by Warren Kiefer

While this is a very educated and sane response, my original point is not exactly addressed. My point was simple, why should a patient have to sometimes wait up to eight hours for a hospital doctor to sign release papers. This hospital doctor being someone who has never provided a second of the patients care. And this being after the patient's primary doctor has already signed release papers.

As I noted previously, once your attending physician has signed your discharge orders, and your nurse has provided you with any prescriptions, discharge instructions, and follow-up appointments, you are free to leave. A hospital physician (Hospitalist) has no bearing if he was not involved in your care. If you are delayed because of a hospitalist, that is a rule of that hospital - and not a common practice. Ask to speak to the nurse manager or supervisor for an explanation. If you get no satisfaction ask for the case manager to whom you are assigned. Still no satisfaction, go (have your advocate/spouse/friend go) to administration and raise a ruckus. A decently run hospital wants to have you leave as soon as your physician says you can. A decently run hospital has case management/discharge planning working on your discharge plan as soon as you are admitted. A hospital with decent management wants to stop incurring costs on your behalf as soon as they can. (For a patient to remain in a hospital hours beyond a reasonable discharge time costs a lot. Meals, perhaps continuing medications, nursing time - all are wasted.)

If this was a practice in a hospital under my responsibility it would not last for long. If it is happening in a hospital you use, my guess is that the hospital is using this process to be sure all the insurance "I"s are dotted and "t"s are crossed. Case management and nursing should be checking things from the time of admission, and reminding physicians to write orders, etc. that way you can leave at an appropriate time. My opinion is that your hospital has a funky discharge process in place - and it's not the nurses fault.

[TVMayor]

The quickest way to get released is go before a judge and post bond.

[RVRoadie]

Welcome to the world of Hospitalists. These are the people that are there to make sure your care meets Federal Standards. Never mind what your doctor says, these people know best. Two years ago, I voluntarily let the ER admit me, against my better judgement. Once you get assigned a Hospitalist (the docs with the lowest bids), your care is out of your hands. After three days, I had to text my wife to come in and hound them until I was released. Never again.

[Warren Kiefer]

Originally Posted by dbussone

As I noted previously, once your attending physician has signed your discharge orders, and your nurse has provided you with any prescriptions, discharge instructions, and follow-up appointments, you are free to leave. A hospital physician (Hospitalist) has no bearing if he was not involved in your care. If you are delayed because of a hospitalist, that is a rule of that hospital - and not a common practice. Ask to speak to the nurse manager or supervisor for an explanation. If you get no satisfaction ask for the case manager to whom you are assigned. Still no satisfaction, go (have your advocate/spouse/friend go) to administration and raise a ruckus. A decently run hospital wants to have you leave as soon as your physician says you can. A decently run hospital has case management/discharge planning working on your discharge plan as soon as you are admitted. A hospital with decent management wants to stop incurring costs on your behalf as soon as they can. (For a patient to remain in a hospital hours beyond a reasonable discharge time costs a lot. Meals, perhaps continuing medications, nursing time - all are wasted.)

If this was a practice in a hospital under my responsibility it would not last for long. If it is happening in a hospital you use, my guess is that the hospital is using this process to be sure all the insurance "I"s are dotted and "t"s are crossed. Case management and nursing should be checking things from the time of admission, and reminding physicians to write orders, etc. that way you can leave at an appropriate time. My opinion is that your hospital has a funky discharge process in place - and it's not the nurses fault.

I LOVE YOUR RESPONSE !! But let me tell you what I was told. First, I recently was told that most hospitals have a Hospitalist. I was also told the same Hospitalist serves both the Villages hospital and the Leesburg hospital. This information came from a board member who did say they were working on the problem of delayed discharges. In my case, my nurse said she had prepared all the necessary paperwork and only that remaining was the release signature of the Hospital doctor. After many hours, I did discuss my plight with the head nurse who told me that if I chose to leave without the hospital doctor's release, there was a chance Medicare would refuse to participate in the cost of my stay. This concerned me enough that I with street clothing on, waited nearly 9 hours for the final signature.

[dbussone]

Originally Posted by Warren Kiefer

I LOVE YOUR RESPONSE !! But let me tell you what I was told. First, I recently was told that most hospitals have a Hospitalist. I was also told the same Hospitalist serves both the Villages hospital and the Leesburg hospital. This information came from a board member who did say they were working on the problem of delayed discharges. In my case, my nurse said she had prepared all the necessary paperwork and only that remaining was the release signature of the Hospital doctor. After many hours, I did discuss my plight with the head nurse who told me that if I chose to leave without the hospital doctor's release, there was a chance Medicare would refuse to participate in the cost of my stay. This concerned me enough that I with street clothing on, waited nearly 9 hours for the final signature.

It is true that most hospitals have hospitalists. I have seen hospitalists employed or contracted by insurance companies. Guess how quickly they want to get you discharged? I have seen Hospitalists employed or contracted by hospitals. The ones I know also want to see you discharged in a timely manner. Keep that board member's phone number handy for the next time (hopefully not) you are in the hospital here. One Hospitalist between two hospitals is a joke. That doc is THE bottleneck in the entire discharge process.

It is generally thought that a census of 15 patients is appropriate for a Hospitalist. (see: http://www.todayshospitalist.com/ind...s_read&cnt=824). Now that's if the doc is managing the care of those 15 patients. As of 2012, any relationship between care provided by hospitalists and improvement in outcomes had not been established. So, we have inconclusive proof that hospitalists have any beneficial impact on patient care. In your case we know they have a negative impact.

[dbussone]

Originally Posted by Warren Kiefer

I LOVE YOUR RESPONSE !! But let me tell you what I was told. First, I recently was told that most hospitals have a Hospitalist. I was also told the same Hospitalist serves both the Villages hospital and the Leesburg hospital. This information came from a board member who did say they were working on the problem of delayed discharges. In my case, my nurse said she had prepared all the necessary paperwork and only that remaining was the release signature of the Hospital doctor. After many hours, I did discuss my plight with the head nurse who told me that if I chose to leave without the hospital doctor's release, there was a chance Medicare would refuse to participate in the cost of my stay. This concerned me enough that I with street clothing on, waited nearly 9 hours for the final signature.

P.S. if Medicare did have a problem you would win the appeal and most likely the hospital would not receive reimbursement. And they could not turn around and try to make you pay. Guess why? You did have an appropriate discharge from your physician, the Hospitalist was an agent of the hospital acting on the hospital's behalf - not yours - and the Hospitalist was not involved in your care.