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W
ith reimbursements declining and
overhead rising, the word of the day
is throughput: treat 'em and street
'em, surgical slang for discharging patients in a
timely fashion. This is indeed a fine line to
walk. While there is nothing inherently wrong
in administering a fast-acting anesthetic and
permitting a patient to return home when com-
fortable, I've seen some borderline discharge
justifications over the past few years.
• 'The block will take care of the pain.' I have heard of
tales of patients who, despite expressing signif-
icant discomfort, were told "No worries, the
block will kick in." The block was administered 2 hours ago! 'Hello,
hello, anybody home? Think McFly!' Blocks may last several hours but
if they aren't working after 30 minutes, Houston we have a problem!
Are the liposomes just warming up to release the bupivicaine? Is the
timed release on Pacific time? Or is the anesthetic home-activated?
• 'The nausea will subside.' The patient may be as white as Casper the Friendly
Ghost and have more dry heaves than a Callahan on March 18 (day after St
Pat's). Yet, they may be quietly assured that the feeling of queasiness will go
away. When — next week? If Zofran doesn't work in the PACU, why
should it work at home? Is the ginger ale at home stronger that what is
given in recovery? Should the patient return to the ER 2 days and minus 12
pounds later? Can Grandma's home remedy do better than the nurse's?
Are We Really Discharging That Patient?
The little white lies we tell our patients to send them home sooner.
Cutting Remarks
John D. Kelly IV, MD
• BORDERLINE DISCHARGE Is that
patient really ready to go home?
David
Bernard
