Husband in ICU since Thursday due to a fall, probably due to Covid. There are no beds available in stepdown unit (holiday weekend of course).
Stats OK per doc. Huge blood clot between lungs was removed. He will probably be discharged tomorrow.
I forget to ask, but shouldn't he be walked a little before discharge ?
We want to teach you a phrase. It's "unsafe discharge".
Your husband should be discharged not to your home, but to a rehab facility.
No fever present.
Proper home care or rehab planned.
No unsafe discharges on my watch!
So your husband is one for whom the clotting problems happened secondarily to covid? That is one of the most dangerous problems they are seeing with covid. Are you suggesting that they have removed a "huge clot" as you say, and then, without progressing to a step-down unit he will be sent directly home, just discharged just like that?
How many days has he been in ICU?
Is he still testing positive for Covid?
What blood thinners have they put him on and what followup will he have?
How old is he?
What is his overall condition? That is to say does he have a history of clotting problems, heart problems, lung problems?
Do they even know if he CAN walk?
And are they WISHING him to walk for clot prevention?
I can't know your husband's condition at all. I can only say as an old retired RN that this wouldn't have happened in "my day". Cardiac stepdown was where I worked. There was no case EVER that I saw that went home from CCU or ICU without stepdown care.
I would be scared to death if I were you.
I honestly cannot assess what is happening here, or has happened; what you tell us is just to little to go on, but the removal of this clot does not sound good to me.
I wish you the very best. As I said, I would be scared. What, honestly, are they even wanting you to watch for, assess him for, act on "if"???
This seems pretty outrageous to me.
husband home yesterday monday afternoon and seems ok.
he went to “stepdown” unit … i dont know how familiar you are with that … the unit between icu and regular admit or discharge … and was able to walk 150 feet … apparently medicare criteria for discharge … so he came yesterday and seems/feels ok.
problem with all this for both of us is that it seemed like only a cold to suddenly hitting the extreme.
The only way to deal with this now … in addition to phone appts with docs … is to put it behind us and move on.
personally i couldnt tell difference between my own sickness and anxiety attacks.
HIS own extra problem was that “clot from hell” i mentioned … i have a picture too … almost-filled vein from lung to lung.
i did use words “unsafe discharge” tho to stop discharge just as it was getting dark sunday night.
thank you so much !
So say you come in with pneumonia. DRG will be, for instance, 2 days. They expect you out on day 2. If so the hospital breaks kind of even, does OK. If you are out in ONE day and then get pills, no IV and are home, hospital WINS and gets GOOD pay. If you are there for 5 days the hospital is a big loser.
You are coded at once. This man is in ICU with blood clot; he will have quite a number of days as will need perhaps surgery perhaps clot buster, perhaps IV blood thinners. So maybe 3 or 4 days. Hospital is a winner if they can get him out in that time. And a BIG WINNER if they can get him out earlier. And a loser if he is in for 8 days. See what I mean. That is MEDICARE payment and nothing really to do with insurance or advantage plans. They will charge you something for every day in but they don't depend on getting you out early. Only the hospital does.
Works much differently than MD office visits and etc.
Look up "What are DRGs" and look up "How do hospital DRGs work."
This basic from the internet:
"When you've been admitted as an inpatient to a hospital, that hospital assigns a DRG when you're discharged, basing it on the diagnosis you received and the treatment that you needed during your hospital stay. The hospital gets paid a fixed amount for that DRG, regardless of how much money it spent treating you."
This is the short and sweet about why the hospital wants you OUT fast.
So tell them you know all about DRGs and you know an "unsafe discharge and will inform JCAHO about it" and they will start shaking in their white shoes.
And yes, I've been through this recently, so feel free to ask.
The OP has already started a new thread, same topic.
WHY?
"Should a patient be walking before leaving the hospital?"
"Walking before leaving hospital Asked 6 min ago by Betsysue2002
To go home prior to being able to walk would be an unsafe discharge.
You may or may not need rehab transfer for a week or so, but you will certainly need some inhome care.
As BarbBrooklyn whose husband was recently in ICU can tell you, they come at you about discharge before they even see a patient come out of coma these days.
You should demand to speak to discharge planning and social services AT ONCE and tell them that you will not accept your husband returning home as an "unsafe discharge". Stress those words exactly as unsafe discharge is reportable to JCAHO and can lose a hospital its licensure.
I wish you good luck.
I hope Barb is around to talk with you; consider shooting her a private message if she doesn't pick up on this thread. She recently went through all of this.
Hope you will continue to update us and am wishing you good luck. You are going likely to need instruction on blood thinners, etc. and some patients return home with family responsible for lovenox injections and etc. This is all important stuff.
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