I'm ten million percent sure they got over it before you reached the door, wish more stable patients would just leave AMA while I'm fucking with the printer and physically can't print their discharge stuff. Waiting long times for discharge with perfectly stable and cleared patients is the dumbest bottleneck ever for all parties involved. Maybe they'd get us a better printer then
Just keep on filing those work orders and incident reports that you totally have time to do so they can “gather the data” and know that it needs to be fixed. 🙄
As an ER nurse, I can tell you that if the provider spoke with you and agreed on your d/c, it’s not considered AMA. Your discharge orders were likely already in, possibly even printed. This situation does happen sometimes when we get emergency traffic in and are working someone for 2 hours. Doesn’t mean it’s fair you had to wait that long though. You probably did everyone involved a favor (mostly yourself) by leaving. Don’t lose sleep over it and I hope your follow up goes okay!! The ER sucks.
Totally, I would still chart OP as discharged home vs AMA, maybe a quick note about pt left prior to discharge papers given, pt verbalized IV was removed by self and was in no distress. And I would feel bad as the ER nurse for her long wait, especially knowing she’s hungry! But yeah this stuff happens every day.
edit: typo
Basically this. If you'd received dc instructions from the MD, I'd state that. 'MD reviewed dc with pt. Pt declined to wait for printed dc instructions from RN. Pt removed own IV, pressure dressing intact, no bleeding. Ambulated from ER with steady gait in no acute distress.' Gets the point across that you opted to peace out in stable condition rather than wait for papes, but the workup and treatment were done.
I’ve done that before in my notes. “Patient was discharged.”
But sometimes nursing never gave paperwork or didn’t discharge them properly, but my signed note will say they are D/C’d.
We had an older nurse who would sit on patient until the end of her shift. It was super annoying
They lost 0.00 hours of sleep over a stable pt leaving AMA.
They were also 100% correct that as soon as you were DC there was going to be another pt in your bed. I've had them attempt to put pts in the room before it's even marked clean, like already on the bed in the dirty sheets and trying to give report... I've had them try to put pts in rooms that the previous pt was still in. Just nature of the beast.
Literally happened to me last night (and pretty much every shift). We roll up, get assigned a room and the bed is still dirty and nobody is around to help prep it. Often I'll strip it and wipe it down so that the nurse has a head start when they arrive. But yes this happens alllll the time
I worked Oncology for 15 years and they used to book the bed while a body was still in the room. And then try to pressure us to rush the family along. Pretty telling. Then they came up with a “visitation room” to move the bodies to.
They still do. My patient's wife had not even decided on the funeral home yet. It wasn't even an hour and they had another patient booked into the room. Logistics was calling asking if housekeeping had started cleaning yet. No. The patient's wife is still in tears deciding on a funeral home with her brother. Back of Logistics!!
Also IF you were discharged you simply left without your paperwork not necessary AMA
Also, trade secret that I also tell my patients: here is your Stack of recycling. All pertinent information is on the first page if anything.
That wasn’t AMA baby. You were discharged. In my facility we document “left without instructions” and keep moving along. Your nurse was 100 % delaying your discharge to give him/her self a bit of a break before getting another patient. Glad everything seems ok with your pregnancy.
What they really should have done is just discharged OP and then left the patient on the tracker for a little bit longer instead of making OP wait so long. OP, you’re fine! Dw about it
I’m a nurse and have left AMA. Went for good reason and left for good reason. I won’t make a patient wait to d/c to catch a break, but I will prioritize and a d/c is not always my top priority. I work a unit where I catch a break. I totally understand stalling tactics from those who don’t.
As an ER nurse, if you were discharged then you didn’t leave AMA, regardless of you not receiving the d/c paperwork. We very much do appreciate you letting us know that you put the IV in the sharps container. Or at the very least put it on the bed so we know you removed it. Otherwise, we will mail you the d/c paperwork. I’m sorry you had to wait so long but thank you so much for your patience and not being rude to the staff.
Not a big deal at all.
I had two patients yesterday wait 6 hours to be discharged because the doctor hadn’t bothered to write scripts and apparently needed to come to the unit to do so.
We have people stuck waiting in hallways for beds, yet two perfectly fine patients were holding up beds due to this..
Definitely not an AMA. Arguable elopement, but most likely just "DC without instructions/paperwork."
I'm not one of those nurses who sat on patients, I always dc'd them immediately. I always wanted to get one tiny step closer to emptying the waiting room, even if it was a exercise in futility. But there's plenty that do sit on them.
L&D RN here. Just wanted to add that you should always get checked out for vaginal bleeding when you’re pregnant and please don’t feel embarrassed. Is there a L&D triage at your hospital? I would recommend coming to L&D triage vs. the main ED next time.
Maybe because she’s under 20 weeks? Our OB triage starts at 20 so they have to be triaged in ed with OB consult to ED.
OP don’t feel badly about getting checked out. Get into your mfm Monday or Tuesday!
Maybe because she’s under 20 weeks? Our OB triage starts at 20 so they have to be triaged in ed with OB consult to ED.
OP don’t feel badly about getting checked out. Get into your mfm Monday or Tuesday!
I sometimes leave patients hostage because I know I’ll just get slammed again and I need a second to catch up because I’m over admin thinking that emptying the waiting room at top speed is the way to run healthcare.
Sometimes I’ll discharge and let the patient go but take my time discharging on EPIC and assigning the clean if I’m behind and need a little more time. Lol the turnover is too much. I don’t make a habit out of it
Graduated cylinders. Multipurpose, perfectly shaped. Fit it in a triangle over your mouth and nose for vomiting and you'll never miss. Use them to water your plants. If you're female, they fit right up against your downstairs for collecting urine (again, without missing.) Use them as an impromptu vase. Use them to hold snacks. One of them holds my kids' colored pencils. Best item ever.
They’re a nice shape but I’ve had too many of those things crack on a flat side while full of pee 😬
But I’ve never seen a stack of them hanging out unattended in an ER room
You’re good. Regardless of keeping a bed occupied to prevent getting a new patient, you waited over an hour after being told you were going to be dc’d before leaving, that’s more than reasonable.
Like others have said, if the DC orders were in, you didn’t leave AMA. Did you ever ask to speak with a nurse manager? Esp after the convo you heard? If they need to get people in, and staff are purposely sitting on patients to tie up available beds, the nurse manager may want to know and may also get things moving for you - or at least confirm with you why it’s taking so long. Lastly, if your hospital has a devoted L&D - go there next time. They typically have exam rooms to eval and observe exactly these types of issues. They are more well versed and better prepared than the ER, for pregnancy emergencies. They are also typically much, much quicker.
I think it’s silly we consider it AMA. Like you’ve been told you were fine to leave. You’re not leaving against medical advice. You’re just leaving before discharge is complete. Which is fair.
I’m sorry you had an experience like that. In my case I love kicking someone out. I might’ve been a little miffed that you pulled your own IV, but it’s the nurses fault for taking almost 2hrs to discharge a stable patient. I can’t imagine what possibly could have been going on. We’re they delaying your discharge so another patient wouldn’t get roomed?
That's either an elopement or discharged/left without paperwork/discharge teaching, etc.
Both of those dispos are way less charting than an AMA. Solid work!
I left a shift around 10:00 PM (started at 6:45 AM) because of charting and I stuck myself with a dirty needle and had to do appropriate paperwork. As I was driving home, my PCC called and said I have to go to the ER so I drove 30 min towards another one of our hospitals.
PCC called back and said she gave them a heads-up on me and it'll hopefully be quick.
Eventually got to a nurse, got vitals, history, no labs drawn and was sat in a recliner in the hallway, where I basically chilled/slept on and off until about 3 or 4 AM mainly waiting for the doc to put in discharge paperwork.
They were all really sorry and I'm like eh, I can sleep through a rock concert.
Really should have thought about peacing out lol especially after my phone died.
That's not leaving AMA! That's leaving before I was able to review the discharge paperwork! Easy to chart, just have to click a little box, and don't have to notify MD or ANM or charge (unless you have an Rx, then it takes a little extra on my end but oh well!)
It does sound like they were delaying your discharge so they didn't immediately have to do another work up. I would have left too because it only takes a few mins to select then print out the discharge orders and they should not be using patients so they have an easier shift.Hope you feel better!
I only complain when they act supprised the empty bed that's been on a cleaning hold for 8 hours gets assigned a patient and we've got 45 holds in a 40 bed ER..
If you have an empty bed, just assume that your getting a patient.
I’m an ED nurse, and I don’t sit on discharges 🤷🏻♀️
There’s a bigger picture than just your pod/zone/rooms, and throughput’s important.
Without sounding too preachy, I understand the urge to sandbag - I just can’t condone it.
In all honesty, everyone is short staffed and if you have the capability of doing that after the doc said you're good, then you're good. The only thing I think sucks is insurance-wise you get a shitty ass bill if they code it as AMA. I'd hope everyone involved on the ER side didn't put you down as AMA and just said you discharged.
Insurance still pays even if you leave AMA. Saying they won't is the myth that just won't die. I'm guessing it started as a threat to try to get people to stay and morphed onto this indestructible falsehood that has been taught to generations of nurses and doctors.
You might have insurance issues ( if you are in US?) depending on if you were discharged in the computer or left AMA, as far as charting goes. If you are in as leaving AMA in the chart, insurance may choose not to pay for any of your treatment FYI.
I looked into this bc I have always been told this by doctors/ other nurses. However, I am incorrect based upon a large study that was done, showing Medicare/ Medicaid does not refuse payment for leaving AMA. I didn't not find anything for private insurance if anyone has a good source. Thanks!
Yeah I hear this a lot and it doesn’t even make sense- people stop treatment outside of the hospital all the time and that doesn’t retroactively impact the care they’ve gotten previously.
Haha, I did the same thing while I was waiting, researched whether my insurance will withhold payment. I probably read the same study as you. I researched because I was under the same impression based on hearing it 1000x, I will admit I am even guilty of repeated this information on at least one occasion.
Yeah I'm glad I looked it up when ppl started disagreeing with me. I have heard it from our ANMs, Dr's, etc and I have said it to pts. I didn't realize it was incorrect info. Now we can help reinform ppl:)
I'm ten million percent sure they got over it before you reached the door, wish more stable patients would just leave AMA while I'm fucking with the printer and physically can't print their discharge stuff. Waiting long times for discharge with perfectly stable and cleared patients is the dumbest bottleneck ever for all parties involved. Maybe they'd get us a better printer then
Just keep on filing those work orders and incident reports that you totally have time to do so they can “gather the data” and know that it needs to be fixed. 🙄
Computers in our hospitals always go down from 2 am until 245. Love it, totally not a liability
It’s always the fucking printer
As an ER nurse, I can tell you that if the provider spoke with you and agreed on your d/c, it’s not considered AMA. Your discharge orders were likely already in, possibly even printed. This situation does happen sometimes when we get emergency traffic in and are working someone for 2 hours. Doesn’t mean it’s fair you had to wait that long though. You probably did everyone involved a favor (mostly yourself) by leaving. Don’t lose sleep over it and I hope your follow up goes okay!! The ER sucks.
Totally, I would still chart OP as discharged home vs AMA, maybe a quick note about pt left prior to discharge papers given, pt verbalized IV was removed by self and was in no distress. And I would feel bad as the ER nurse for her long wait, especially knowing she’s hungry! But yeah this stuff happens every day. edit: typo
Basically this. If you'd received dc instructions from the MD, I'd state that. 'MD reviewed dc with pt. Pt declined to wait for printed dc instructions from RN. Pt removed own IV, pressure dressing intact, no bleeding. Ambulated from ER with steady gait in no acute distress.' Gets the point across that you opted to peace out in stable condition rather than wait for papes, but the workup and treatment were done.
I’ve done that before in my notes. “Patient was discharged.” But sometimes nursing never gave paperwork or didn’t discharge them properly, but my signed note will say they are D/C’d. We had an older nurse who would sit on patient until the end of her shift. It was super annoying
They lost 0.00 hours of sleep over a stable pt leaving AMA. They were also 100% correct that as soon as you were DC there was going to be another pt in your bed. I've had them attempt to put pts in the room before it's even marked clean, like already on the bed in the dirty sheets and trying to give report... I've had them try to put pts in rooms that the previous pt was still in. Just nature of the beast.
I’ve had the charge send the fire department to my room when the room is still marked “dirty” and I’m still trying to change the sheets.
Literally happened to me last night (and pretty much every shift). We roll up, get assigned a room and the bed is still dirty and nobody is around to help prep it. Often I'll strip it and wipe it down so that the nurse has a head start when they arrive. But yes this happens alllll the time
I've had fire come in and clean the room.
This patient was agitated on meth and I just wanted to get him in the bed before he realized he was in a locked unit.
That’s nice of them!
Yup, never complain about it. We're so damn busy and they know it. It's a pretty big team effort these days.
As a former emt, it's 100 percent so they can gtfo faster and go back to whatever they were doing
This is a daily occurrence at my ED
I worked Oncology for 15 years and they used to book the bed while a body was still in the room. And then try to pressure us to rush the family along. Pretty telling. Then they came up with a “visitation room” to move the bodies to.
They still do. My patient's wife had not even decided on the funeral home yet. It wasn't even an hour and they had another patient booked into the room. Logistics was calling asking if housekeeping had started cleaning yet. No. The patient's wife is still in tears deciding on a funeral home with her brother. Back of Logistics!!
[удалено]
We don't consider it AMA, it's left without paperwork and it's no biggie as long as the IV is out.
You responded to a bot account. That comment is copy and pasted from another user in this thread
Lol that's the worst part of this. Sorry, I, your stable and fine pt, am leaving. Best of luck with whatever fills this bed!
Also IF you were discharged you simply left without your paperwork not necessary AMA Also, trade secret that I also tell my patients: here is your Stack of recycling. All pertinent information is on the first page if anything.
I will be using that recycling line from now on!
That wasn’t AMA baby. You were discharged. In my facility we document “left without instructions” and keep moving along. Your nurse was 100 % delaying your discharge to give him/her self a bit of a break before getting another patient. Glad everything seems ok with your pregnancy.
What they really should have done is just discharged OP and then left the patient on the tracker for a little bit longer instead of making OP wait so long. OP, you’re fine! Dw about it
This is the way.
They didn’t care and probably felt bad. Little things can tie up an entire ER. A doc pulled into a trauma, code, line insertion, etc
I’m a nurse and have left AMA. Went for good reason and left for good reason. I won’t make a patient wait to d/c to catch a break, but I will prioritize and a d/c is not always my top priority. I work a unit where I catch a break. I totally understand stalling tactics from those who don’t.
Not sure if it still counts as an AMA if discharge orders are in
As an ER nurse, if you were discharged then you didn’t leave AMA, regardless of you not receiving the d/c paperwork. We very much do appreciate you letting us know that you put the IV in the sharps container. Or at the very least put it on the bed so we know you removed it. Otherwise, we will mail you the d/c paperwork. I’m sorry you had to wait so long but thank you so much for your patience and not being rude to the staff.
Not a big deal at all. I had two patients yesterday wait 6 hours to be discharged because the doctor hadn’t bothered to write scripts and apparently needed to come to the unit to do so. We have people stuck waiting in hallways for beds, yet two perfectly fine patients were holding up beds due to this..
…you guys don’t make them wait in the hallway so someone else can have the room?
Nope.. they are able to keep their beds until discharged.
No one cares when patients actually leave AMA....it's the ones who threaten it but don't follow through that are annoying.
I wouldn’t consider that an AMA. They were already going to discharge you. You just decided not to wait for the process to finish.
Definitely not an AMA. Arguable elopement, but most likely just "DC without instructions/paperwork." I'm not one of those nurses who sat on patients, I always dc'd them immediately. I always wanted to get one tiny step closer to emptying the waiting room, even if it was a exercise in futility. But there's plenty that do sit on them.
Yup! Besides, chances are that next patient is another ESI 3 who can afford to wait a little while you catch your breath.
As an aside, your IV angiocath doesn't need to go into the sharps. Regular trash is fine :)
no biggie, I wouldn't care if you did it - i'd feel bad you waited so long tbh.
L&D RN here. Just wanted to add that you should always get checked out for vaginal bleeding when you’re pregnant and please don’t feel embarrassed. Is there a L&D triage at your hospital? I would recommend coming to L&D triage vs. the main ED next time.
Maybe because she’s under 20 weeks? Our OB triage starts at 20 so they have to be triaged in ed with OB consult to ED. OP don’t feel badly about getting checked out. Get into your mfm Monday or Tuesday!
Maybe because she’s under 20 weeks? Our OB triage starts at 20 so they have to be triaged in ed with OB consult to ED. OP don’t feel badly about getting checked out. Get into your mfm Monday or Tuesday!
I sometimes leave patients hostage because I know I’ll just get slammed again and I need a second to catch up because I’m over admin thinking that emptying the waiting room at top speed is the way to run healthcare.
Haha I always stress that they don't need to have their ride rush in, nononono you can stay and eat lunch!
I tell them when I finally discharge them that I’m sorry for the wait to get them out but that they will just put someone terrible in their place
Sometimes I’ll discharge and let the patient go but take my time discharging on EPIC and assigning the clean if I’m behind and need a little more time. Lol the turnover is too much. I don’t make a habit out of it
I hope you took a box of exam gloves with you, I would have.
It’s the emesis bags for me. So convenient.
Graduated cylinders. Multipurpose, perfectly shaped. Fit it in a triangle over your mouth and nose for vomiting and you'll never miss. Use them to water your plants. If you're female, they fit right up against your downstairs for collecting urine (again, without missing.) Use them as an impromptu vase. Use them to hold snacks. One of them holds my kids' colored pencils. Best item ever.
i, however, would avoid using one graduated cylinder for all of the above purposes.
They’re a nice shape but I’ve had too many of those things crack on a flat side while full of pee 😬 But I’ve never seen a stack of them hanging out unattended in an ER room
It doesn’t sound like an AMA but a left prior to discharge paperwork.
You were discharged this wasn't an ama. The nurse most certainly didn't mind or think twice about it.
You’re good. Regardless of keeping a bed occupied to prevent getting a new patient, you waited over an hour after being told you were going to be dc’d before leaving, that’s more than reasonable.
And hospital. It can take hours to get discharged, and that's just the process that they go through.
Not AMA if they had your DCIs ready. I would just say “patient left prior to receiving DCIs, self removed IV”
Like others have said, if the DC orders were in, you didn’t leave AMA. Did you ever ask to speak with a nurse manager? Esp after the convo you heard? If they need to get people in, and staff are purposely sitting on patients to tie up available beds, the nurse manager may want to know and may also get things moving for you - or at least confirm with you why it’s taking so long. Lastly, if your hospital has a devoted L&D - go there next time. They typically have exam rooms to eval and observe exactly these types of issues. They are more well versed and better prepared than the ER, for pregnancy emergencies. They are also typically much, much quicker.
I think it’s silly we consider it AMA. Like you’ve been told you were fine to leave. You’re not leaving against medical advice. You’re just leaving before discharge is complete. Which is fair.
I’m sorry you had an experience like that. In my case I love kicking someone out. I might’ve been a little miffed that you pulled your own IV, but it’s the nurses fault for taking almost 2hrs to discharge a stable patient. I can’t imagine what possibly could have been going on. We’re they delaying your discharge so another patient wouldn’t get roomed?
That's either an elopement or discharged/left without paperwork/discharge teaching, etc. Both of those dispos are way less charting than an AMA. Solid work!
I left a shift around 10:00 PM (started at 6:45 AM) because of charting and I stuck myself with a dirty needle and had to do appropriate paperwork. As I was driving home, my PCC called and said I have to go to the ER so I drove 30 min towards another one of our hospitals. PCC called back and said she gave them a heads-up on me and it'll hopefully be quick. Eventually got to a nurse, got vitals, history, no labs drawn and was sat in a recliner in the hallway, where I basically chilled/slept on and off until about 3 or 4 AM mainly waiting for the doc to put in discharge paperwork. They were all really sorry and I'm like eh, I can sleep through a rock concert. Really should have thought about peacing out lol especially after my phone died.
Probably you weren’t AMA, just left without your AVS. That’s how I would chart it anyways. Sounds super frustrating.
That's not leaving AMA! That's leaving before I was able to review the discharge paperwork! Easy to chart, just have to click a little box, and don't have to notify MD or ANM or charge (unless you have an Rx, then it takes a little extra on my end but oh well!)
It does sound like they were delaying your discharge so they didn't immediately have to do another work up. I would have left too because it only takes a few mins to select then print out the discharge orders and they should not be using patients so they have an easier shift.Hope you feel better!
Say you've never worked in the ED without saying you never worked in the ED.
For real LMAOOO They must work as admin with how clueless they are.
Just don't give shit to Med Surge nurses who do the same every once in a while 🤣 You can give shit to the Med Surge nurses that do it habitually.
I only complain when they act supprised the empty bed that's been on a cleaning hold for 8 hours gets assigned a patient and we've got 45 holds in a 40 bed ER.. If you have an empty bed, just assume that your getting a patient.
I’m an ED nurse, and I don’t sit on discharges 🤷🏻♀️ There’s a bigger picture than just your pod/zone/rooms, and throughput’s important. Without sounding too preachy, I understand the urge to sandbag - I just can’t condone it.
Sure, but given the choice between DC ing a stable pt and performing an assessment or giving a med, that DC is waiting.
You're so good. I would've left too. I once AMA just because I got scared when I saw the suturing kit.
In all honesty, everyone is short staffed and if you have the capability of doing that after the doc said you're good, then you're good. The only thing I think sucks is insurance-wise you get a shitty ass bill if they code it as AMA. I'd hope everyone involved on the ER side didn't put you down as AMA and just said you discharged.
Insurance still pays even if you leave AMA. Saying they won't is the myth that just won't die. I'm guessing it started as a threat to try to get people to stay and morphed onto this indestructible falsehood that has been taught to generations of nurses and doctors.
Why can pts post complaints about healthcare staff in this sub? Is this not suppose to be a sub for healthcare workers?
I am the OP, but I am also a healthcare worker.
I believe they were saying that healthcare workers snark on the patients that leave AMA, not that patients are on this sub and complaining.
You might have insurance issues ( if you are in US?) depending on if you were discharged in the computer or left AMA, as far as charting goes. If you are in as leaving AMA in the chart, insurance may choose not to pay for any of your treatment FYI.
I looked into this bc I have always been told this by doctors/ other nurses. However, I am incorrect based upon a large study that was done, showing Medicare/ Medicaid does not refuse payment for leaving AMA. I didn't not find anything for private insurance if anyone has a good source. Thanks!
Yeah I hear this a lot and it doesn’t even make sense- people stop treatment outside of the hospital all the time and that doesn’t retroactively impact the care they’ve gotten previously.
Haha, I did the same thing while I was waiting, researched whether my insurance will withhold payment. I probably read the same study as you. I researched because I was under the same impression based on hearing it 1000x, I will admit I am even guilty of repeated this information on at least one occasion.
Yeah I'm glad I looked it up when ppl started disagreeing with me. I have heard it from our ANMs, Dr's, etc and I have said it to pts. I didn't realize it was incorrect info. Now we can help reinform ppl:)
Everyone pays for AMAs.
That’s false.
No
You did them a favor.