Bed Blocking – Contentious Subject

If a consultant said you were OK to go home from hospital, would you jump at it or say you still feel ‘not upto it’.

I’ve been there a few times, literally let out of hospital within a couple of hours ‘coming round’ as the day ward was closing (after a 3 hour op) – I was well up for escaping, despite wobbling to the car. Desparate to get out after nearly 7 weeks in with a broken sine.

BIL is early 60’s and has been in for surgery for his gall bladder to be removed – fairly urgent stuff as been in lots of pain. Op initially delayed as consultant not happy with BIL’s heart. Operation has gone OK, some minor complications but the docs say he can go. Except SIL and BIL don’t want him to go home ‘yet’. I suspect SIL doesn’t want to be babysitting him as he’s a moody git at best, and a right wimp (her words more or less).  Now, he ‘missed’ the doctor today as he’d gone for a ‘walk’ to get a paper – something he’s been doing for a few days.

MrsF suggested to her sister that wandering around the hospital probably means he is OK enough to go home. He doesn’t want to yet, and SIL was somewhat angry it was suggested.. To me, that’s bed blocking, but that’s me – I’m all for getting out.

They are worrying he’ll be back in with complications if he goes home, but they are less than 5 minute drive from the hospital. Given he’s not ‘terribly well’, and the current risk of ‘covid’ one would try and get out to spare a bed.

I accept that’s my opinion, but I’m all for getting out when I’m allowed. You recover better at home getting rest.

Some people have rational,  to them,  health anxieties which makes them fearful of discharge, and how they will cope. There’s no point trying to understand it ad its perfectly reasonable/ rational to them ?‍♂️

I’d say his treating team need have a chat, explain risks of both going and staying and advising they are discharging him if they feel he is medically fit.

Whether he wants to or not, if the hospital team decide he’s fit enough, he’ll be discharged (assuming he doesn’t need a social care package). Unfortunately the current circumstances don’t allow ‘another night just to be sure’ when there are people on being nursed on trolleys in the back corridor of the ED as there aren’t enough inpatient beds to meet the demand.

DOI Hospital consultant.

He does suffer ‘health anxiety’ – has mild AF, but won’t do anything to improve his health, like gentle regular exercise. He gets in a flap if he starts getting out of breath (which is fairly normal if you are exercising).

It doesn’t look good when you aren’t there to talk to the doctor about discharge, as you’ve gone for a walk. He doesn’t need any care package, it’s that there is some infection there, but with meds and outpatients aointments it shouldn’t be an issue. I can see SIL being the driving force to keep him there as she won’t want to look after him.

The thing is that even without the bed pressures there’s a decent amount of evidence that just being in hospital is associated with harm.

I’d have thought that if they’ve clocked that he’s well enough to walk to the shop for a paper and is off antibiotics and the drains are out, he’ll be discharged pretty soon.

You can be medically fit for discharge but if your social / rehab needs can’t be met you’ll be kept in hospital until they can, which can be months, it’s bonkers, but thank the governments for that.

Your free to leave at any time though as long as you have capacity to make an informed decision.

We in the UK expect the NHS to do an awful lot that could potentially be done by placing those demands upon family. Western expectations.

The longer you stay in hospital the more chance you have of becoming unwell…

My wife came home the day after a spinal operation – lumbar decompression for cauda  aquina syndrome. Just had to satisfy the physio her movement was good enough and she had help at home. Couldn’t wait to get out and the bed was needed for someone else.

It was an example of the NHS being superb. She got as same day GP appt when the symptoms developed. Her GP recognised what it probably was and admitted her the same day. After she was scanned a consultant surgeon spinal specialist told her she was getting the op the next day.

This is NOT bed blocking.  Bed blocking is where you are fit for discharge but the support you need at home cannot be put in place for a variety of reasons.  This is normally following an assessment made.  This is someone not wanting to leave hospital tho fit to do so and able to be looked after at home.

Its selfish and entitled  to do this.  He needs to leave the hospital – no ifs buts and ands.  He can go to a care home on a short term basis if he wants to and this is usually possible to be arranged very quickly.  I suspect BIL is going to be having some frank discussions with the consultant and social work.  They can use the police to remove him and he may end up on a “do not admit” list if his behaviour continues

It’s a shame they can’t invoice him, £1000 quid a night might make him think about how much of a selfish tool he wants to be

I’m  veering towards TJs point of view, fit enough to go home, required support in place, you go home.

Though marksparks alternative of US style billing has a certain attraction as well!

I’d just like to say I agree with TJ. For the novelty value!

We in the UK expect the NHS to do an awful lot that could potentially be done by placing those demands upon family. Western expectations.

That’s not “western”, in Spain your family would be expected to care for you. No idea about other countries.

I’m with you. It’s not a hotel.

When my mum was hospitalised last year she spent half a day on a gurney in a corridor between Resus and a ward.

I’d just like to say I agree with TJ. For the novelty value!

Bookmarked, copied, kept for posterity 🙂

PS I agree, he should go home, especially if anything does go wrong they are five minutes away.

If you can go for a walk for a paper, you are well enough to go home.

Bookmarked, copied, kept for posterity 🙂

To be used in evidence against you….

She got as same day GP appt when the symptoms developed. Her GP recognised what it probably was and admitted her the same day. After she was scanned a consultant surgeon spinal specialist told her she was getting the op the next day

Aye, cauda equina is a kosher urgent indication – big risk of premanent nerve damage

Can only blame governments for failing to have back ups in place. They put an impossible choice on the person. And not every single case is the same and you can’t look at one and say it is indicative of them all.

If theres no or little family, or those that are there as themselves not fit and healthy enough to go running about for another person, then how can they be blamed for wishing to stay put until they feel well enough to manage on their own.

Older single people prefer to be in their own space, but they are people so can recognize their own failings. So lets not punish them for it.Besides the system was initially put in place so they wouldn’t have these worries, and it is up to the government to make such things possible.

So blame lies with successive governments, and in particular the tories. who it would appear rather look to business interests than the health and wellbeing of its people.

Personally I’d rather stay at home, but im at least fit enough to look after myself with minimum help from the family, or at least not a 12/24h care system.

Mrs LD is a community occupational therapist, she has no end of issues with trying to get people home, but there’s a lack of social care availability to allow it, and often they are limited in what equipment/adaptations they can get organised in time to get them out of hospital. It is most definitely a broken system with private  social care businesses in general only wanting to do the basic minimum, and her budgets for equipment and adaptations totally slashed to the level that they’re over budget almost as soon as they get it, along with everything tightened criteria to try limit those spends. Nightmare.

My experience is the opposite of this.

Ready to go home the morning after a procedure and cleared for take off at 9.30, just have to wait for a prescription.

Still stuck in the place at 4.30.

After one of my kids was born we were ready to leave at 10am, not finally cleared to leave until 6pm and only then because we were just going to walk out unless they signed us off.

Co-incidentally both in the same hospital – Fairfield. It must be a culture there.

Given FGH labour ward shut >10 years ago that’s not all that recent experience?

Ready to go home the morning after a procedure and cleared for take off at 9.30, just have to wait for a prescription.

Still stuck in the place at 4.30.

I had exactly the same, almost identical timings.  Backlogs in the pharmacy apparently.  I was desperate to leave.

Different hospital.

I had similar… waiting for the hospital pharmacy before discharge.. in the end I was discharged anyway but I needed the prescription – the hospital said it would send it to my house via taxi??!?!?! not great use of money – Wonder how often they do that?

As luck would have it I had a friend who worked local to the hospital so he was able to swing by and grab it 2 days after, which is ok as I had enough meds four about 4 days with me anyway… I can’t quite remember what happened as I was dosed up on codiene and antibiotics, but if memory serves, one of the ward nurses gave me it out of the supplies they had on the ward.

After breaking my spine, I was waiting for the day to go. Finally the Consultant agreed I could go, but the prescription wasn’t ready (morphine and anti-coagulant injections) but having been waiting all day, and the pharmacy then being closed, I got them to agree to let me go and I’d arrange for the prescription to be collected (Friday evening before I got out). I left it for the weekend, and got a reminder to get my prescription collected ASAP (worried about blood clots from being bed bound for 7 weeks).

BIL is early 60’s and has been in for surgery for his gall bladder to be removed

 I suspect SIL doesn’t want to be babysitting him as he’s a moody git at best, and a right wimp (her words more or less).  Now, he ‘missed’ the doctor today as he’d gone for a ‘walk’ to get a paper – something he’s been doing for a few days.

My GF had her gallbladder removed back in September. Op. was in the morning and I picked her up and brought her home that afternoon.

There is no way she could have gone for a walk anywhere, it was difficult enough getting her to the car, in the car, back out the car and into her house. I had to stay at her place that night and work from her house the following day to look after her, she couldn’t even cook a meal. Her daughter came over to look after her the following day.

BIL sounds okay to me, walking out to get a paper ffs.  TJ is right, he needs to leave asap.

He needs to be pointed to the exit door – and quickly. Whether or not his missus wants him to be discharged and returned home is an irrelevance and they both should be made fully aware of that.

Brief case/mitigation for the defence, having been a hospital pharmacist for many years:

Pharmacies are poorly staffed at the best of times and of course can experience illness/absence above that now & then.  However, it’s also true that being told that you can go is not the same as being told that your prescription has been written and made available to the pharmacy – especially if it’s a consultant telling you on their morning round.  One of their minions will write it but very rarely will it be there and then, as the team will stay with the boss until their round (probably on multiple wards) is complete.  At that point the poor junior doc (or nurse-prescriber sometimes) has a whole load of accumulated jobs to catch up on, urgent calls to see patients , relatives to talk to etc and so still the takeaway prescription may take a back seat.  (I’ve had multiple experiences of overhearing (while there for other purposes, typically early afternoon) a patient on a ward being told that pharmacy is holding them up and I usually make a point of going over & looking the pt up on my laptop to see if I can clarify.  Far the most common finding is that no document has been generated and ward staff are incorrect in what they tell a patient)

If you’re ever told that you can go, it’s a very sensible strategy to ask “who will be writing my discharge document – and when?” and if you’re ever told they’re waiting for the drugs, ask if they can confirm that the prescription has actually been written and the pharmacy has it (there may well be a tracking system).  We used to take in a very significant proportion of our day’s takeaways between 5-7pm and I bet that a lot of those had been “waiting” most of the day

It is massively in a hospital’s interest to get patients out ASAP and nobody deliberately undermines that but ALL hospital depts are understaffed and, contrary to assorted political opinions, that rarely breeds efficiency in any of the multiple steps in a discharge.

(Disclaimer:  Never worked at Fairfield)

If theres no or little family, or those that are there as themselves not fit and healthy enough to go running about for another person, then how can they be blamed for wishing to stay put until they feel well enough to manage on their own.

When my mum was discharged, they put some sort of ‘Enablement’ service in place, she had free home visits for a few weeks.  As it happened she wasn’t particularly Enabled and wound up back in hospital from which she didn’t return home again.  Point is, that service should be available to the BIL?

@cougar It doesn’t sound like he needs intermediate care, especially if he’s well enough to go and get the paper.

Again, places are limited so unless he has a demonstrable need he won’t be getting one.

Someone choosing to stay in hospital I’d suspect some underlying mental health issues. I’ve not been in one myself other than as a visitor but it looks like an utterly grim experience and is certainly terrible for health.

How come you had a broken sine? Just cos?

Anyways…sounds like other reasons than acute need for him not wanting out, so maybe find out what they are and what you (collectively) can do about them and in a short time frame

How come you had a broken sine? Just cos?

Nothing like taking a thread off on a tangent.

@scaredypants

No disrespect intended, it was obvious that everyone was doing their absolute best.

But there has to be a better way. They ended up giving me a cooked lunch they didn’t need to and as the guy came round to check on my evening meal choice 20 mins before serving,  I presume that was also budgeted for.

It all had that ‘for want of a nail vibe’.  If its a common issue why not just increase the capacity of the pharmacy?

I want to like the two posts above mine but like doesn’t work and I am still labeled as a freeloader.

Sorry.

Labeled as a free member.

I’ve always mithered the hospital staff to get home asap, not sure why you’d want to stay unless you like a sweaty back with noisy fellow patients interrupting your sleep. And I have generally have enjoyed my stay in hospital.

Nowt queerer than folks though, and some just love the attention in hospital.

BIL is early 60’s and has been in for surgery for his gall bladder to be removed – fairly urgent stuff as been in lots of pain.

Mum in her 70s has been on the emergency list for the same op since November, in constant pain. They unblocked the duct back in March, and finally removed the inflamed gall bladder last week. There would have been more delay if she hadn’t kept badgering them (she worked in NHS for ~30 years). They gave her meds she told them didn’t agree with her, plus removed the painkillers she lives on for other issues, so ended up staying in overnight. She’s in good shape now but a week or two away from driving.

Presumably the subject of the OP is reading the paper in his own home now.

Yeah agreed on god knows why anyone would ever want to stay in a hospital a minute longer than required

I remember when I broke my wrist, they admitted me on Tuesday and wouldn’t let me go home until the op, on Friday. Given I lived 10 min away I saw zero benefit of staying in a hospital bed rather than my own at home, however they told me if I discharged myself they wouldn’t be able to book in the op. I remember sleeping in the visitor room one night as the ward was so noisy and the Old boy in the bed next to me kept shitting himself.

I’m  veering towards TJs point of view, fit enough to go home, required support in place, you go home.

perhaps, but it does make the assumption that the support HE believes he needs is actually going to be in place.  Eg, if SIL is not actually going to help him, or he has stairs to manage etc – going to get the paper may not be a true reflection of fitness/readiness.  I suspect that urgent readmission for a problem is not a 5 min drive, but a 5h wait in A&E (or at least that’s his perception).

It all had that ‘for want of a nail vibe’.  If it’s a common issue why not just increase the capacity of the pharmacy?

because 9/10 times the pharmacist is not in ear shot so the patient will conveniently think it’s pharmacy rather than the doc having been too busy in the morning or the junior doc having made a mistake on paperwork (the pharmacy is there as a safety net to trap such errors).  Oddly, 90% of discharge prescriptions are entirely predictable the night before.

and why is none of this fixed?  Because it’s politically acceptable to say “we will Spend X on nurses/doctors” but not acceptable to say we will spend X/2 on managers and clinicians and managers seem to believe they are in opposition.