u/TruthWarrior27

Anybody else surprised a discharge to a facility ever happens?

There are so many barriers: morning labs came back and the kidney function continues to worsen (discharge cancelled), the patient's new oxygen requirement didn't undergo a respiratory activity and nocturnal study (discharge cancelled), the facility doesn't want the patient because they've been on continuous observation 1:1 in the last 24 hours, they don't want them because they've been on video monitoring in the last 24 hours, the one admitting nurse on site can't take the patient back after 12pm, social work needs to set up transportation and nothing's available, the resident has to put in the discharge order and prepare after visit summary in advance (they do it minutes before the ride is set to pick the patient up instead), the pharmacist then has to look over the meds to verify accuracy, then you have to print the after visit summary and look it over to give discharge education (or more realistically stuff it in a belongings bag as you rush to get them the hell out of the hospital), then you better have called the facility first thing in the morning and bounced around on the phone until someone begrudgingly has taken report, then get the patient's IV out, vitals taken (better look baseline!) get them dressed and pack their mountain of junk supplies and six hospital cups they want to take back with them, then call escort to wheelchair them to the pickup spot before the ride social work set up calls up and says they're leaving because you took so long.

I would say something like 80% of discharges to facilities are unpleasant, rushed experiences. Anyone else experience this?

I talk about this with coworkers often because it makes up the majority of patients in med surg, but how long has medical management actually been so "good" that patients can be kept alive with some of the worst quality of life imaginable?

Why is a patient in a vegetative state with an anoxic brain injury who has a trach and a PEG still kept alive other than the ability of medicine teams to order IV abx for the chronic aspiration pneumonia, heparin for the blood clots, or electrolyte and RBC repletion from the daily labs?

Why is the depressed, anxious, poorly controlled diabetic amputee with ESRD still alive other than dialysis, and inpatient diabetes management and wound cares?

Why is the 85 year old with agitated dementia who doesn't eat or drink still alive other than tube feeds or TPN and intermittent doses of seroquel/haldol/zyprexa to sedate that are begged for from nurses to residents who seem more concerned about "side effects" and "delirium" than the living hell that these patients appear to be in when awake and interacting?

When did society decide it's morally and ethically best to allow people to be medically managed and kept alive in a state that resembles humanity but is essentially anything but?

It's really disturbing, sickening, and sad how many people are alive with a quality of life that is arguably worse than death.