What should you do when a patient refuses to leave the hospital? A reader asked me the question:
i am a nurse that practices in an acute care hospital. i have run into several patients lately that "refuse" to be discharged when the hospitalist writes up the orders to do so. These patients are appropriate for d/c as they are medically stable and being sent home w/appropriate scripts, f/u, and instructions. Have you run into this and what is your feeling or your colleagues feelings on this matter? It astonishes and infuriates me as it impedes my job as the rn.
That's a great question. I have run into this in the past. I blogged about it here.
For Medicare, you give them "The Letter". Medicare allows their beneficiaries to refuse to be discharged from the hospital if they don't think it's right. At this point, if the patient refuses to leave, some magic force inside the Medicare National Bank reviews the chart and makes a determination if discharge is justified. This can take up to 24 hours. If the MNB agrees with the doc, then Medicare will refuse to pay for anything past the discharge date. You tell the patient their insurance has run out and I've never seen anyone refuse to leave.
For Private Insurance. There is no review process that I'm aware of. If the patient has received discharge orders and refuses to leave, they should be informed that they will be self pay, at self pay rates. At over $1000 a day, I've never had anyone refuse to leave
Medicaid (and uninsured for that matter). Since they pay for nothing and there is no "letter" policy like Medicare, the patients don't care one way or another. In these situations, I tell them they have been discharged and my job is done. What happens next is up to the hospital. If the hospital wants to escort the patient out with security, that's up to them. But I stop rounding on a patient that refuses to leave, in whom I have discharged. It has never come this for me.
How do you all handle this situation?
