I worked as a "discharge planner" in the TRACU, a step down unit, for trauma patients at Legacy Emanuel Hospital, which is a level one trauma center. We received patients with the worst types of injuries. Being an urban inner city hospital we received our share of patients with stabbings, gunshot wounds, etc. Patients, of course, are treated whether or not they had health insurance or funds to pay. If they survived their injuries and were admitted they typically spent time in critical care ICU, and once improved they were moved to a bed in the unit where I worked, where nurses and therapy staff were adept at providing the sometimes specialized care that these individuals required. As a discharge planner there was great pressure from MDs and the hospital administration to discharge patients the minute they no longer required care in a hospital setting. This makes perfect sense, however many patients, in order to leave a hospital setting required care in Rehab., skilled nursing facilities or if they could be discharged to home would need access into their house (you cannot get into your house if you have stairs and you have two broken legs!) and someone there to care for them. Since many of the patients had no insurance or inadequate insurance and little or no family/friend support it became very challenging to discharge them. The hospital cannot just put them out on the street. Therefore, many patients ended up staying in a "trauma step down bed" until such a time when they were significantly improved or until we could get them onto the Oregon Health Plan via Title XIX. Needless to say, the trauma patients continued to be admitted into the hospital day and night and as those patients needed to come out of ICU there were often no beds available on our unit because there were patients who we could not discharge (because of insurance or whatever). This leads to MDs, administration and other staff continually asking the discharge planner "When is Mr. X going to be discharged? He's ready to go! Have you found a place yet?". The administration gets upset because hospital beds equate to money. When a patient is in the hospital who technically does not need to be there it costs the hospital money and it forces patients who are in ICU to either stay there longer or get transferred to another floor (Orthopedics, for example) where the nurses/staff are not accustomed to caring for those trauma types of injuries AND the trauma MDs get frustrated because they have to make a trip to other floors in the hospital in order to care for their patients (vs seeing them all in one unit). Needless to say it was a thankless job where expectations on the discharge planners was unrealistic. The corporate climate there was "frosty" with little or no support. Although the care provided was outstanding to the patient, many a staff suffered from that corporate environment.
Do not forget in spring of 2005 when the group of Trauma MDs at Legacy Emanuel threatened to go on strike if they did not receive increased salary and they offered to work for Free at OHSU emergency rooms! Talk about commitment.
posted 4 years, 6 months ago
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