My Day At the Hospital....

1 My brother has been inpatient for 3 days for a perirectal abscess with surgical debridement. Dressing changes are quite challenging, requiring an entire kerlix packed wet to dry, plus outer dry dressing. Dressing change required after every BM.Hospital is an hour away from my home. I received a call from my brother, telling me that surgeon was discharging him to home today. No longer medically necessary to keep him inpatient. Home Health was being arranged.

Husband and I set out for hour's drive, arrive @ 1:00. Social worker is in the room, states that she's "arranging the home health agency" for dressing changes. We sit patiently, visiting with my brother, waiting for arrangements to be finalized. Brother is going to stay with 80-year-old parents, on the assumption that medical needs/dressing changes will be taken care of primarily by home health nurse, plus myself. After 2 hours, we put on the call light and ask RN how things are going.

She immediately says "well, I don't think discharge tonight is a reasonable goal. The insurance company is balking at paying for home health nurse since the patient can walk, talk and feed himself." Well, yes, he can do all of those things, but he CANNOT change his perirectal packed dressing. Nor can his 80-year-old parents. I mention that today is Friday, and to my knowledge, not much can be accomplished with insurance companies on Saturday or Sunday. Nurse assures me that oh yes, we will get this accomplished tomorrow if not tonight

Another 2-hour wait. I'm preoccupied with being a PATIENT patient advociate. At the end of the 2 hours (6:00), I go to the nurse's station. Politely ask the RN: "has there been any progress?""Oh no," she says. "You guys might as well go home."Apparently, social worker has gone home, insurance company closed down an hour before, yet no one as said word one to us. Seething inside, trying to keep my cool so as not to make my brother feel bad.So.....insurance company would rather pay for 1-2 extra inpatient days' stay, rather than a home health nurse? And the nursing staff? knowing we were sitting there from out of town, waiting for discharge, and they can't even update us on the progress/lack thereof?

And no, the RN was not running around like crazy, tending to other patients. There were a total of 6 patients on the floor, with 3 RN's (I counted on one of our numerous walks around the unit).Suppose that my brother didn't have a nurse for a sister? Suppose he allowed himself to be discharged to his elderly parents' home without a plan for dressing changes because he didn't know any better (and he is not an unintelligent person - just not experienced in the medical field).I hate hospitals and I hate insurance companies. I just don't know which I hate most. Last edit by TheCommuter on Jun 24, '12 : Reason: reformatting
I'm sorry to hear about your experience. Sometimes bureaucracies are operated inefficiently and seem so very nonsensical.

Maybe the nurse didn't know you were there from "out of town" to take your brother home? Even when she did know, she said, "we will get this done tomorrow, if not tonight."I drive an hour to work each day. It's a stretch to call that "out of town" as if it's a huge burden. The nurse has no idea where you live or why you're there. Your brother called you....not the nurse. For all she knows...you're there to visit. Assuming you're a nurse, you should know that these things happen. Unless your brother called you saying he was being discharged THEN....he wasn't being discharged yet. The doctor wrote discharge orders...that doesn't mean he's ready to be picked up.

It is the lack of decent communication here that is at issue more than anything else. The patient himself deserved an explanation of what the hold up was after he'd been told discharge orders had been written. I really don't think there is any arguing with that.

Quote from not.done.yetIt is the lack of decent communication here that is at issue more than anything else. The patient himself deserved an explanation of what the hold up was after he'd been told discharge orders had been written. I really don't think there is any arguing with that.

Believe me, I am not saying the nurse is to blame. It was the social worker in the room who openly stated discharge by that evening was a reasonable goal, leaving them to anticipate going home. This individual then decided to leave for the weekend without updating the patient and/or family.

This kind of lack of communication with the patient and family is unacceptable. I experienced a terrible lack of communication when I was recently in the hospital- despite the nurses doing "bedside report." It bought me an extra 1-2 days on an inappropriate unit before I was transferred to the place I needed to be. This is beyond frustrating.

And let me tell you, 1-2 days when you're stuck in a hospital bed is a looooong time. Not to mention the extra money it is costing my insurance co, and myself.

Home Health is an option, but the question I would want answered is what exactly is your brother going to do when the dressing has to be changed after each BM? A Home Health nurse would certainly do a daily dressing change (providing that your brother is homebound)--but if you are going to be needed to do the dressing change after peri-care, I can see the point that a better discharge plan is going to have to be put into place. Unfortunetely, at the end of the day it is hard to put all of these ducks in a row. Yes, communication was not optimal, however, at least you were party to the conversations regarding the discharge plan. Perhaps a better option would be an outpatient visit daily for dressing changes, and you may have to hang out with your brother for a few days.....anyways, as a nurse you know that doctors are just looking at the wound, not at the big picture. Your brother is fortunate that he has you to help him look at the big picture. I would have the social worker call you when the plan is in place, and then call the nurse when you are on your way to hold discharge teaching until you get there, as if you are going to participate in his aftercare, you need to know what to expect. And as a complete aside, If the wound is large enough that it requires such packing, I would explore the option of a wound vac. Then perhaps the wound would heal quicker, and home health could be involved as a skilled need. (not meaning to sound like he needs a vac to get the visits covered--not my intent--just that the wound sounds pretty massive and may take a considerable time to heal)

Quote from minnymiMaybe the nurse didn't know you were there from "out of town" to take your brother home? Even when she did know, she said, "we will get this done tomorrow, if not tonight."I drive an hour to work each day. It's a stretch to call that "out of town" as if it's a huge burden. The nurse has no idea where you live or why you're there. Your brother called you....not the nurse. For all she knows...you're there to visit. Assuming you're a nurse, you should know that these things happen. Unless your brother called you saying he was being discharged THEN....he wasn't being discharged yet. The doctor wrote discharge orders...that doesn't mean he's ready to be picked up.

Quote from jadelpnHome Health is an option, but the question I would want answered is what exactly is your brother going to do when the dressing has to be changed after each BM? A Home Health nurse would certainly do a daily dressing change (providing that your brother is homebound)--but if you are going to be needed to do the dressing change after peri-care, I can see the point that a better discharge plan is going to have to be put into place. Unfortunetely, at the end of the day it is hard to put all of these ducks in a row. Yes, communication was not optimal, however, at least you were party to the conversations regarding the discharge plan. Perhaps a better option would be an outpatient visit daily for dressing changes, and you may have to hang out with your brother for a few days.....anyways, as a nurse you know that doctors are just looking at the wound, not at the big picture. Your brother is fortunate that he has you to help him look at the big picture. I would have the social worker call you when the plan is in place, and then call the nurse when you are on your way to hold discharge teaching until you get there, as if you are going to participate in his aftercare, you need to know what to expect. And as a complete aside, If the wound is large enough that it requires such packing, I would explore the option of a wound vac. Then perhaps the wound would heal quicker, and home health could be involved as a skilled need. (not meaning to sound like he needs a vac to get the visits covered--not my intent--just that the wound sounds pretty massive and may take a considerable time to heal)

Frankly, I think 5-7 days in LTC would have been the more appropriate discharge....

Quote from morteFrankly, I think 5-7 days in LTC would have been the more appropriate discharge....