Wheeled to the hospital exit

by Walter Olson on September 21, 2012

The site My OB Said WHAT?!? sums up a paradox that many hospital visitors have noticed:

“You’re not ready to leave until you can walk out of here.” – L&D Nurse to mom being wheeled out upon discharge.

Many hospitals do hold to a formal policy on the subject. Thus Methodist Hospital of Houston: “When your doctor has discharged you and you are ready to leave, you will be escorted out in a wheelchair by hospital staff.” Why necessarily in a wheelchair, when you may be perfectly capable of walking?

The Chamber-backed Southeast Texas Record has a theory. It’s the same theory endorsed at Yahoo Answers. As for whether patients actually fall and hurt themselves on the way out of the hospital, it appears from this Eastern District of Pennsylvania case (PDF) that, yes, it happens.

{ 5 comments }

1 Paid Worker 09.21.12 at 8:39 am

And don’t forget the “general practice” reinforcer to stupid practices — if it’s now “general practice” in hospitals to wheelchair discharged patients out the door, even if that “general practice” doesn’t make any statistical sense, you’re still even MORE subject to liability if you don’t follow it. “Everyone else is doing it…why didn’t you?” “Better safe than sorry.”

2 Jack Olson 09.22.12 at 9:55 am

What does it say about the standard of care in American hospitals when nearly all the arriving patients are healthy enough to walk in but the departing patients aren’t healthy enough to walk out?

3 wfjag 09.25.12 at 4:01 pm

So, Paul Ryan was just discharging that lady.

4 asdfasdf 09.26.12 at 1:34 am

Playing devil’s advocate here, I could envision reasons why such a practice might make sense. The key factors to consider, which I do not think anyone would contest, are:

(1) Just-discharged patients, as a class, are orders of magnitude more likely to fall than non-patients: they are often sick; on powerful drugs; in a weakened state; or coming off long bedrest.

(2) Just-discharged patients, as a class, are far more likely to get seriously injured if they do fall than non-patients: they may have stitches or be recovering from an operation; their balance might be off, and so on.

(3) Walking through a hospital can be more difficult than walking in a familiar home to some: the floors are slippery, they can be crowded or bustling. Patients may not know just how far the walk even is – the walk might be quite long.

(4) If a patient does fall and injure himself in a hospital just after being discharged, the protocol for readmittance, not to say the legal status and claims would be complex, to say the least – far more so than in a typical slip and fall.

(5) Doctors are very busy.

(6) It’s not that easy to determine whether a patient is always safe to make the walk. Patients can be weak or disorientated and not even realize it; they might know just how long the walk is or how strong they are. It’s quite common for patients to feel fine in bed or with very light exercise, but still to fatigue very, very quickly after, say, an operation.

Due to (4) and (2), hospitals naturally want to be very cautious here. Due to (1), the only way to determine which patients could safely walk to the door would be for the discharging doctor to individually assess whether the patient could do this safely. This evaluation, due to (6) would be time-consuming and due to (5), would be expensive.

Thus, although it is true that many patients could walk out the door, it is simply inefficient and wasteful for doctors to make that assessment individually. It’s cheaper and more efficient for everyone to be escorted.

I am loath to defend the current medical system, but this particular hospital practice does not seem unreasonable to me, given (1)-(6) above.

5 Kenton A. Hoover 09.30.12 at 6:06 pm

I’ve walked out of hospitals. The cases where I hadn’t were (a) when I literally couldn’t walk (was on crutches but they won’t let you use them) and (b) when I was out of surgury less than a day before. Apropos the TSA made me walk through the metal detector on crutches when I didn’t “have to have” a wheelchair. But they have the FTCA protecting them.

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