I have worked with several hospitalized clients who are told they are "being discharged today". Then they wait and wait and wait. Recently, a friend's 90-year-old mom was finally discharged at 9 PM. She was exhausted. Because she was "supposed" to be discharged earlier, the hospital never fed her either.

I can only think this must have something to do with either holding the patient longer to get paid for another day or the workload is so extreme due to hospital understaffing policies. Maybe holding the patient until the next shift means less work?

Can anyone shed some light on this and more importantly, how can patients get discharged earlier and out the door at a normal time?

We have also been told that if the patient leaves earlier, they will be deemed AMA (Against Medical Advice) and insurance will not pay. We have not found this to be true at all. Any thoughts?

Thank you.

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Was in the hospital 3 months ago. Was discharged at 3 in the afternoon. which was surprising; tt depends on how busy the hospital and staff are probably for many hospitals.
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Confounded Dec 2019
True. We're in an HMO that owns and operates its own hospitals and medical offices.

This year, we've personally experienced under-staffing, and under-equipping, and crowded ERs. Because of these conditions, we've also seen well-justified strikes and other labor actions reported on the local newscasts.

Gurneys are in short supply. ER rooms are in much shorter supply. Admissions/discharge *decisions* can take many hours.

Recently, I waited on campus for 12 hours before a decision to admit my DH was made. Decision to admit came around 3:30am. AM.

Staff is overwhelmingly, for most part, very good to MORE than excellent. Their working conditions? Unsatisfactory. To be kind.
My thoughts are, it’s beyond annoying, like being held captive, and it needs whatever overhaul and improvement to treat people better. I could also get on a roll about emergency departments, honestly I wonder sometimes how they save anyone when I’ve watched the sluggish pace so many times (apologies in advance to those in healthcare who do a great job, I know you exist and definitely appreciate you)
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Lol CM!
"Keep her fed, watered."

Like a plant, or a dog.

How can I go to sleep if you are making me laugh?
Best answer of the night.
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I sympathise so strongly with your annoyance about this that my thoughts are not repeatable in polite society!

Here in the UK we wouldn't have the same suspicion about financial incentives to keep the person in for an extra day (the opposite, if anything), but the problem is just the same. The poor patient is rousted out of bed at six, washed, dressed, breakfasted and packed up ready to go, signed off as medically fit for discharge by, say, 9:00 am - and then.... tumbleweeds. The bustle of the ward goes on around them. They wait, and wait, and wait...

There is a gallery of suspects.

#1 Pharmacy. Everybody blames pharmacy. Until the patient's medication is delivered to the ward, the patient cannot leave. At my local hospital, there has been a recruitment drive for volunteer messengers - the idea being that we'd be running up and down corridors with the drugs and the patients would escape more quickly, hurrah! But although we do need people to carry packages from the pharmacy (on the second floor) to the wards (mainly not on the second floor), the real bottleneck is that the pharmacy is overwhelmed: EVERYBODY in the hospital wants their px NOW! - and there is only so much that mere mortal pharmacists can do.

#2 Porterage. Everybody also wants porters NOW. But porters are much better at shrugging off demand, and as far as I can see they will amble about in their own good time and allow nobody to hurry them unduly - often by vanishing for hours on end.

#3 Transport. This splits into a couple of difficulties - a) nobody knowing how the patient is supposed to get home, including the patient; and/or b) nobody having booked the transport, partly because of a); and/or c) the driver (often a volunteer) being expected to be on four different wards to collect four different patients at precisely 16:05 hrs. Then misunderstandings arise: patients who have been sitting in the non-emergency ambulance waiting for it to set off despair and wander off, or need the loo, or become hostile through discomfort; so that by the time the driver gets back with Patient #4 he is missing two others and has to go and hunt for them. Meanwhile, waiting patients will have rung friends, family or taxi services and made their own way home without thinking to mention it to anyone. Or have fallen in the bathroom and are lying there undiscovered.

I think what we need is a departure lounge, staffed by discharge clerks who have special authority to torture pharmacists, chain porters to a kind of conveyor belt, and use cattle prods to make patients SIT THERE AND DON'T MOVE.

If you have a family member or friend who is leaving hospital, meanwhile - try to make sure someone is with her to find her somewhere to sit or lie down comfortably and keep her fed, watered, and as far as possible informed. Waiting without knowing why is incredibly stressful in itself.
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freqflyer Dec 2019
The hospital where I do volunteer work started last week with a "departure lounge". That way everyone leaving the hospital is gathered in one area, and hopefully the right hand knows what the left hand is doing.

That gives the hospital staff a chance to clean up the hospital room and make it ready for the next person coming in from the ER, without having to wait hours for an open bed in the main hospital.
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The patient is not expected to be there, so the last thing on nursing staff's mind is providing a meal.
Ask them, or have the doctor order a meal.

I think the tie up is the doctors must write the orders, and they do rounds at all hours now. Like it was mentioned.

There outta be a law against late night discharges.
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Our system's usually better with discharges than admissions, but ...

... on my DH's most recent hospital stay, they called as I was driving over to visit, and told me they were discharging him right away - not expected, I thought we were looking at another day or two - but - OK. The Care Coordinator wanted to meet with me - also right away.

Got there within minutes. Had to wait an hour for the "right away" Coordinator to arrive. DH requires a weekly shot for anemia - I'd reminded docs and nurses of this from the ER on (only because they did not seem to think it necessary).

They *really* did not want to give it to him, nor would they let us go so he could get it before the lab closed (hospital, medical offices and labs share the campus). Finally, his nurse got hold of the doc, who finally agreed to order the shot.

Another 2 hours passes. Pharmacy still has not issued the medicine. I politely ask whether I should go to the pharmacy to inquire about the shot. By sheer coincidence, a new nurse arrives, syringe in hand, 5 minutes after my inquiry.

Now vitals must be checked (a Good Thing). By then, it's dinnertime. DH's blood glucose is (uncharacteristically) low, so he NEEDS to eat before leaving ... and then, to wait a specified time for another glucose reading.

"Right away" took 4-1/2 hours, give or take. Somehow, with help I was able to pour him into the car from transport chair, then from car into the house on my own.

This was a vast improvement over his first stay, where I was told I HAD to be there before 9am. We were not allowed to leave until 5pm. He'd been prescribed a powerful pain drug. We waited ... and waited ... and waited. Finally, the pharmacy confessed to the on-duty doc that the drug required complex new procedures for dispensing, and they were reluctant to move forward. I went down to the pharmacy myself.

Drug magically appeared. (He never did need it. Never even opened the bottle.)
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I would like to know why, too. It seems cruel to let someone sit/lay in bed late in the day like that and they might be sundowning, too. Then they are exhausted and hungry when they get to rehab. Wake up the next day and you have PT and OT in their face.
Wish there was a smoother transition for the elderly. Really everyone, but mostly the old folks. :(
(to add I felt pretty bad for the ones at the AL/rehab place my Mom went into because she was complaining loudly about being hungry and I heard part of what her care team had to say-they didn't know I was there) I thought oh no, here we go yall.
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Patients once had to be out by noon.
Everyone used to rush to help them get out.
A bit of patient/family/ and even team involved discharge planning would help.
My sister was in the hospital for emergency surgery. She was told that she “ could not” go home for a certain number of days and “must” have rehab, so all services prepared for that. She was not prepared for discharge, nor taught to care for her surgery because rehab was expected to take care of that.
Suddenly she had to go home “within the hour, surprise !”
Wow.... no one in the hospital had figured out in all those days that her insurance did not cover their “plans”.
There is a great void in the system.
This was one of the “nice” stories.
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My experience has been that it's primarily a twofold process/issue: (1)  doctor, and (2)  next of care arrangements. 

Doctor has to make rounds, make the decision to discharge, then do the charting.  Nurses have to follow up, prepare discharge instructions, etc.

Discharge planner in the meantime may have to ensure that any follow-up treatment, such as rehab, is taken care with, with sending charts, speaking with admins, ensuring there's a bed, etc.    Non emergency transit may have to be arrangements; ambulances may not be readily available.  I've waited a few hours for ambulances, in some cases.

If transit is to home, the family needs to be notified and arrive.

All of these are coordinated, sometimes with good results, sometimes with delays. 

In one instance, the nurses didn't bother to call me before I left for the hospital, just for a visit, and I was told then, on the spot, that my father would be discharged in an hour or so.

Given that I wasn't previously advised, I didn't bring the oxygen, as I certainly don't carry it in the car in the wintertime.  So arrangements had to be made to borrow oxygen equipment from the in hospital DME supplier before we could leave.

Often one little step isn't done timely, and the whole process shifts.
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I don't know the answer to this question but I would like to offer a word of advice. If the hospital wants to release your loved one on Friday evening or anytime through the weekend (especially if they are going to an ALF or SNF), try to get them to wait until Monday. It can be very hard to get medications figured out by the nurses at times, and if the person needs pain medication and the doctor hasn't ordered it, or has left a important medication off of the discharge paperwork, they will often have to wait until Monday to get the error fixed. In my state, pharmacies will not accept discharge orders for pain meds from the accepting ALF/SNF. The order has to be sent directly from the physician to the pharmacy, and attending doctors who sign the release usually will not do this. And the Medical Director at the facility usually will not prescribe for the patient until he/she has seen them as they have often never had this person as a patient. It is very hard to watch someone go for several days, in pain or without a medication they need, and be unable to help them. Some facilities will not accept admissions on Fridays or the weekend because of this. Of course, most DO because they don't want to lose the 3 day income.
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I think elderly parents are particularly likely to be released later in the day.  They generally have more wrong with them, and the hospital may want various sign offs, including a cardiologist, and an assessment by a PT that they can walk.  A younger person might just need the specialist that is the issue that got them now. The hospitals do NOT want you to come back, the need a variety of people to assess.
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As Willie says, its the doctor. Some come in early, one I know came in at 7am. He actually discharged Mom Thurs morning to be released to rehab on Friday. He did office visits in the afternoon. Other doctors do office visits during the day, doing hospital rounds after 5. Once discharged by doctor then everyone else has to do their thing to do to complete the process. And you can be discharged AMA. Medicare, Medicaid and insurances will pay for time in the hospital or facility. The hospital is just protecting themselves. Has to do with patient being readmitted later for the same diagnosis.
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I was recently discharged from hospital at 9:00 p.m. because that was when the doctor was available to sign the discharge papers. I've got to say I was getting pretty antsy too, I was afraid they were going to keep me another night.
I think somebody dropped the ball with her meal though, people enter and leave care all the time and getting food (even if it isn't a preferred selection) shouldn't be that difficult.
(Full disclosure - I'm not in the USA but I think healthcare bureaucracies everywhere have similar challenges)
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Because discharge is a process and, depending on how complex the hospitalization and the services that need to be coordinated and patient and caregiver education that needs to be done for safe discharge, it takes hours. It's not like checking out of a hotel!
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That whole AMA thing and the insurance not paying is a myth. It’s a common misconception amongst medical professionals. It’s simply not true.

There are multiple reasons why patients get discharged so late. So we can’t give you a solid answer. There are probably multiple patients that need to be released in addition to all the patients not being released who have to see the doctors and be attended to by the nurses and nursing assistants.
When my husband had back surgery, he was released at 8:30pm and that’s because 1)he wasn’t the only patient being released & paperwork had to be done 2)physical therapy had to come adjust his walker and show him how to use it to get out of bed and he wasn’t the only patient they had to see and 3)someone had to come in and help him get dressed and he wasn’t the only patient needing help. 4)the surgeon had to release him in between seeing other patients and performing surgeries. When I had my daughter, I was released at 9:30am by my doctor. We couldn’t leave until my daughter had been released and that didn’t happen until 2:30-3pm because I had her on Christmas Eve and the pediatrician went to church on Christmas Day (the day we were released) and didn’t get to the hospital until the afternoon! By the time the paperwork was done and we were wheeled out, it was almost 4pm.

I don’t think hospitals release patients late at night so they can charge more money. Because they charge the same whether you are released at 9am or 9pm, either way the insurance gets billed for the entire day.
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