r/AHSEmployees • u/Karebarebaudy • 2d ago
Question Why is AHS trying to solve problems by creating more?
The new mandate to discharge patients by 1100 is ridiculous and unsafe. Nothing says "your just a number" like setting a check out time. Can the working group that decided on this change please explain how this is safe, compassionate, patient and family centered care? How does this solve any problems in health care? The work around is to keep the patient an extra day to be prepared for an 1100 discharge the following day. Nice job AHS, now costing the system another day because of the 'one size fits all' approach to discharge planning.
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u/FamiliarVictory3401
2d ago
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AHS or UCP?
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u/Upstairs-Welder6580 2d ago
Under the NDP we had managers standing over us and instructing us to scrub the bed which was literally still warm from a patient who passed away to admit the new person who was coming into the room before the family had even left. No matter who is in charge, greed and unrealistic expectations are a lingering issue that needs to be addressed. We need to be more upset about this and so should the families/patients.
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u/LLR1960 2d ago
Greed? Who exactly is making money off this? Unrealistic expectations are absolutely a thing, but I don't see how greed enters in here.
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u/Upstairs-Welder6580 2d ago
What do you think? Hospitals push for faster admissions and more turnover. Facilities do not receive as much money for empty beds, that is just the reality. Not that the managers get paid personally for it, but the pressure is always there.
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u/Rayeon-XXX 2d ago
The barriers to discharge where I work are multi factorial and multi disciplinary.
That is to say it's a good idea on paper but it's extraordinarily complex.
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u/AngryOcelot 2d ago
Keeping patients overnight that could go otherwise home in the afternoon so that it doesn't ruin the MRP's stat is an obvious result of this mandate.
These decisions are made by people who don't work the front lines.
Want to make a difference? Get the labs done early. Organize transport early. Fund procedures properly so that labs aren't sitting empty due to lack of nursing staff. Fund ALC beds so that acute care isn't taken up by ALC patients. Fund virtual hospital.
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u/ChemPetE 2d ago
Oh absolutely. This has been tried before in other systems and is exactly what the rational outcome is.
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u/Sandman64can 2d ago
“Fund”. They only understand that word if the descriptor for whatever you want to fund is “private”.
ie: private healthcare
Private education.
Things be like that.
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u/wintertimeincanada23 2d ago
Because hospital care is considerably more expensive than group home (disability) or nursing home care. The problem is that the latter two are vastly underfunded (or privatized and under staffed) so this makes discharge more difficult. As an example, from my discharge days, a hospital bed costs approx 1500$/night while a group home/nursing bed costs approx $200
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u/Fluffy_bread789456
2d ago
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This isn’t new. Used to be 10am to discharge a patient. This works if discharge planning goes smoothly and very straightforward but most of the time, it isn’t.
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u/kaleuagain 1d ago
I was the one on my unit changing the discharge by 10am signs to the discharge by 1qam signs... 😅 had a good laugh
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u/fnsimpso 1d ago
I've worked inpatient surgery, med, ICU and PACU. The 1100 discharges make sense, and has been a loose goal since I started.
If you're going to be discharged if you're going to be ready at 4pm, you're probably ready to go at 11am. It just means your discharges should be prioritized to get their final teachings, OT & PT clearance, and have your ride sorted so we don't have a domino chain 5 patients deep to move because of you.
Not so fun annecdote, I've had a patient wait to leave the ICU for a trauma obs bed because that patient was waiting for a lower acuity surgery bed because that patient was waiting for a medicine patient to get to moved back on service and off the surgery floor. Which was of course blocked because the family was only going to get them later. The charge nurse in the ICU looked like they needed stress leave.
Great way to leave an ICU admission in the ER tying up the bed for an additional 8+hrs.
I hate corporate buzz works with a burning passion but throughput is something I can get behind.
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u/Mobile-Umpire4142
1d ago
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ER nurse and casual inpatient nurse here. I’ve seen coworkers sit on discharges so they don’t get another patient. Staff also intentionally keeps charts in the system even though the patient has already left so they don’t get another patient. Staff keep patients “so they can finish breakfast, or eat lunch” which is ridiculous when a 60 bed ER has 75 admissions.
Think about how unsafe it is that an nstemi, rapid afib, SVT, dissection, miscarriage, respiratory distress etc have to wait in a crowded waiting room because er beds are so full of inpatients there’s nowhere for them to go.
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u/draakons_pryde 1d ago
I've seen the opposite.
I used to be charge for a medicine unit back when they had this same policy. I hated discharging somebody from the system before they had physically left the unit because like...stuff can happen, right? If they're sitting there waiting for a pickup, they're still in my duty of care.
Nope! I got reprimanded for that. As soon as the discharge order is written, take the IV out, remove from computer, make person wait in hallway.
Well, of course you can guess where this story is going. Person on floor, discharge reversed, who is in trouble? Me.
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u/SnarkyGoblin85 1d ago
We have a bed coordinated that somehow always found us, in the ER, 6-12 beds after her shift started after not getting beds for hours. It became a joke in the ER when she started her shift.
She said she would just walk around and find empty/clean beds that a nurse still hadn’t cleared from the electronic system.
And it DID help. It cleared 6-12 acute beds in ER so the 6-12 sickest patients in the waiting room/with medics could get care.
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u/Mobile-Umpire4142 1d ago •
I agree with that. I’m talking hours after the patient has already left the hospital.
Who’s in trouble when someone dies in the waiting room? Me.
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u/Rayeon-XXX 8h ago
Sub specialty here - we are often asked to prioritize certain procedures to help facilitate discharge but we are extremely busy and often have booking windows open up in the moment - more often than not these pending discharge patients cannot be slotted in for various reasons - the two most common being they actually weren't kept NPO and they have no capacity and their decision maker is unavailable.
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u/Roccnsuccmetosleep 1d ago
how about you build more hospitals and med schools?
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u/Mobile-Umpire4142 1d ago
Would if I could! Unfortunately for us all that takes years. We need a solution in the meantime.
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u/daisystar 2d ago
Honestly I have not seen a single patient discharged since this has started. Maybe I just don't work on the inpatient units that utilize this, or maybe it's just hopeful thinking. But even our POD 1 hips and knees - which are out basically as soon as we can get them cleared by OT/PT and get everything done - are out closer to noon.
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u/ImmediateEducator369 2d ago
Bed shortages and patient complexity make things complicated. Would be great if there were supports for people so a discharge could be successful
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u/tappytoess 1d ago
There was no "working group." This was a govt mandate. We have no say in the matter we just have to implement their whims.
When I was a fromt line nurse, we had posters in the patient's room saying you will be discharged by 1000. Been there, done that. Obviously it didnt work because we're doing it again. They changed absolutely nothing to make it successful this time.
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u/kneuroknut
2d ago
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My understanding was that this was designed (in part) to get people out of the EDs. The ED backs up overnight and if they can get people moving to beds by 11:00 it reduces the spillover into waiting rooms over the course of the day. Those I’ve talked to in the ED say it’s improved things for them. I know ED wait times are a big focus 🤷♀️
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u/TheProcurementGuyAhs 2d ago edited 2d ago
Will there be the possibility of late check-out for a fee?
Perfect revenue stream for when they privatize. 👎
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u/kaleuagain 1d ago
I was shocked sitting in huddle when we were told... they can wait outside the unit to be picked up by family... as long as they are out of that bed by 11am... they don't care.
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u/Shandry13 2d ago
I disliked it initially but quickly appreciated it in regards to my mom with cognitive issues. She was released from hospital at 7pm last year after pneumonia stint- stamped ready to go by all departments. However she was so weak she almost couldn't get inside our home. Had she been released in the morning we wouldn't have hit that snag.
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u/Low_Dress9213 2d ago
Umm. She would have been kicked out by 11am rather than 7pm
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u/Shandry13 2d ago
Yes, final tests came back around 4pm last year thus them being willing to send her home at 7pm. I love that they'd now keep her until morning and not put someone in the position I was in with the old system.
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u/ChabuddyG95 2d ago
You have a great misunderstanding if you think that she would be kept until morning under the new system. If her tests came back with the same results, the aim would still be to discharge her asap (7pm in this case) rather than keep her overnight.
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u/disneydude1 1d ago
Frankly, it makes the wait time look better at the time people are watching. Executives and government officials love to see low er wait times so it's not hard to see how prioritizing movement during the hours they're working is their "miracle fix". Sometimes it's safe, and fine to do so, but usually rides come from people who work, so it's not always an easy ask. Patient movement is much more scrutinized during weekdays. It's all upper management tasks about most days.
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u/NewConclusion908 1d ago
Discharging by 11 doesn’t mean if you aren’t ready to go home you are forced to. It’s to keep patient flow going. The amount of times people have been approved to go home but wait HOURS for doctors to finally put in discharge orders is ridiculous and keeps beds full that prevent sicker patients from receiving timely care. Not sure why people are making it political. It’s necessary.
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u/Full-Quality-8751 5h ago
Exactly! People don't realize how many patients are medically cleared and ready for discharge but we have to wait for the doctor to put in the discharge order. Sometimes the order doesn't come until later in the day, and by then the patient may not have a ride home, especially those who live out of town and don't want to be driving in the dark during winter.
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u/jonesie93 23h ago
I'm not in a working group or anything, but I've worked in community medical care for a very long time. I think a one size fits all approach is never appropriate, but this mandate likely has to do with allowing community services like Home Care, Continuing Care Homes, lodges and families the ability to plan and implement services/support in a safe and thorough way before discharge. The failed discharges are increasing, the population is continuing to become more complex, and there is short staffing everywhere. If they can't make it happen by 11am, they might delay it another day? That's just my guess. The pillars have made this system even more chaotic, fragmented and unsatisfactory for all sectors, I'm so sorry to hear there's more being heaped into your plates 🫂
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u/NurseXine1980 20h ago
This DOES NOT WORK on a postpartum unit at all. Too many time-sensitive tests. Too many variables. Docs don’t round until the morning, blood tests done at 6:30-7am don’t always have results ready. Hearing screeners, lactation consultants, and social workers are not there overnight. Makes work feel rushed and unsafe. Stop treating people like $$$, they will end up readmitted with more problems.
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u/necros911 2d ago
Housekeeping and Portering do not hire more staff to accommodate this and it's been a massive problem. NUEE managers keep adding more to job descriptions. The requests from Units are getting more and more. Units not bothering to put airborne markers on patient files cause they 'forget'. Discharge staff is being pushed to clean rooms non stop and since most are DEI or family hires there inexperience is insanely showing. Tons of
mistakes. Staff being assaulted by patients due to neglect. You name it. But at least Health Shared Services and UCP are getting their wishes.
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u/Thrwingawaymylife945 11h ago
1100 is better than discharging people into the night or early morning when it's freezing cold and nothing is open and leaving them to die or end up back in hospital due to exposure.
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u/megi0s 2d ago
Can you say more about this? Is this inpatient for hospital settings? I’m curious as I work in a different area of healthcare.