Originally Posted by KyWoman (Post 1001875)

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

Originally Posted by dillywho (Post 1001338)

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.

Originally Posted by graciegirl (Post 1002117)

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

Originally Posted by Warren Kiefer (Post 1007579)

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.

Originally Posted by dbussone (Post 1007618)

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.

Originally Posted by Warren Kiefer (Post 1007906)

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.:clap2:

Originally Posted by Warren Kiefer (Post 1007906)

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.:clap2: