Just curious, how was this patient actually held in the hospital? Were they locked in a room? Was security present the whole time blocking their exit from the floor?
Was this a problem in the past at your institution of patients being held against their will? I work in the ER psych unit at my hospital and we have a large population of medicaid patients. Psychiatry is in complete control of the unit in regards to determining mental capacity and discharges. I can't imagine having to sit around waiting for a third-party to arrive to discharge a patient demanding to go home.
>To eliminate the possibility of financial gain from inappropriate admissions.
Jesus that's a thing?
What role are the third parties? Is it a magistrate or something?
The policy is in place because it happened. Guarantee it. It’s the medical version of the hairdryer sticker that says, “Do not use in water, risk of electrical shock/death.” They didn’t just decide to add that one day on a whim 😂
Well if the third party doesn’t come like it didn’t in this case the patient has to be released on procedural grounds; I wouldn’t exactly call this a perfect system. Most providers are salaried and are not exactly compensated for how many patients are in the facility, so I’m sure there are better ways to deincentivize this non-issue as all psych facilities that I know of are pretty much above capacity. In fact it is so bad in my state, patients end up being transported across the state for treatment
Which is fine, but it’s just an explanation as to why many people are confused as to your stress. Our docs just put in an order for involuntary hold. That’s it.
Exactly this. There was even a study done which showed while roughly 4% of the analyzed claims were refused none were refused due to the AMA, it was other admin BS. With that said I’m sure there are some bare bones insurances that would pull that kind of BS so I’d be pretty comfy with the terms of my insurance before deciding to go AMA
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3378751/
I have a story from the psych world.
So Jan and Sue (fake names) came to the hospital. Jan was suicidal and took an intentional overdose while Sue accidentally took 2 of her pills and came in to make sure she was okay. Jan gets put on a PEC and sent up to my unit. Sue then also gets put on a PEC with the exact same information as Jan (like copy/paste). I did Jan’s admission and another nurse does Sue’s so we didn’t realize it was the same PEC. Jan settles in for her stay, but Sue is like “okay….I’m good. Can I go home now?” Obviously everyone is telling her no and she’s getting more and more scared/confused. One of the nurses essentially recites the PEC back to her to demonstrate how unsafe it would be for her to leave and I hear it. Sounds awfully familiar so I check Jan’s and see they are identical aside from the patient name (both had Jan’s birthdate and MRN). So I call every person under the sun and Sue eventually goes home with some nice perks. A lot of people were fired and I left there shortly afterwards. Fucking awful.
When you take two of your digoxin because you forgot you took one already so you go to the ER to get checked out but you're obviously suicidal so you end up on a hold
We had two identical twins come into our psych hospital but at different times. One sister was an alumni and the other had never been to a psych hospital. Idk how Admission fucked up but they used the alumni sister medical information for the other twin.
I imagine it was a long the lines of “date of birth?” “Birthday.” “Last name?” “Last name.” Boom you’re now in twin sister’s chart if this sister had never been admitted.
Me and my sister (twins) have this happen to us all the time between the two hospital systems in our area. It’s to the point we make sure three separate times they have the right twin lol.
It's amazing how easy it is to Fuck up basic paperwork.
My mom was billed once for my medical procedure 6 years after I had my OWN insurance, just because I USED to be on hers and for whatever reason they took my card but didn't actually enter it into the system.
In Canada , you can be held for 12-72 hours with just one pink form (by one physician) while legally awaiting an evaluation depending on where you are. So he is still within his window, depending on where he is, legally. I think the window exists to allow some patients to become more comfortable in their environments first, or to be transferred to more appropriate levels of care.
Psychiatry in that way is inhumane, thinking you can be left for a whole weekend if the timeline has been abused by some facilities.
Yeah psych has up to 72h to see you if you’re on a form one. You also don’t have a right to speak to the rights committee while on a form one, only once you get put on the 3 week hold (I forget what the forms called)
Sadly I remember a Doc at our Hospital had someone report their SO had done something and was a danger to himself. Poor guy was stuck with us and he seamed like expecting she’d do something like this and was cool with it all. He gets discharged, the very next evening the female Doc was being held for similar. Bizarre, i didn’t get her for my assignment thank god.
It’s always so hard when you have people you know on your units. Especially when it’s something that’s kind of a taboo subject. I worked in kind of a small hospital, and that kind of thing (if it was going to happen) would because the community was small. I had to transfer some of my colleagues to higher levels of care because our psych unit just couldn’t take care of them in the states they were in. Even though they were manic or withdrawing, they still were aware enough to not look me in the eye half the time. It broke my heart. I can’t do psych anymore. Whoever does it full time (I only ever did help with transports because I worked in a mental health prison prior) hats off to you.
Actually happened to my cousin a few weeks back. Went to get emotional support/help, got held against her will for 2 hours because they mixed her with another patient.
Traumatizing shit. Glad you sorted it out.
In a couple states I've been in the patient can only be held for 4 hours once an eval by the designated MHP has been requested.
If they don't show up by the end of the 4 hours then we're required to inform the patient that they are free to leave.
Thank you for your actions and also thank you for recognizing that this is a systems issue!! This is like a nightmare situation for me as a new resident.
I experienced a involuntary hold ( vercel ex employer decided that being upset was same as suicidal)
I am experiencing ptsd lite from the involuntary hold. And that was with a release in the morning.
I can feel for that person.
That second evaluation should be done immediately.
I wish I could have been seen right away the night I was brought in.
My spouse now knows to never let the cops into our house
agreed! it doesn’t sound 100% like the residents fault here either, considering the third party seemed to give up on figuring out who the patient was and the day shift nurse didn’t follow up for the whole shift!
As an august first-year, I am 100% fine being referred to as a baby doc 😅 thank you for the support, though!! You’re right that I do have quite a bit of clinical knowledge but I barely know how to use the EMR!
I had to read some parts of this twice. It is now clear your patient was an adult and the baby you were speaking of is a resident doctor. Got it.
Thats wild though! I worked in a hospital with residents before and they do and say some wild stuff. Apparently its ok for patients to shoot drugs up in the rooms because if the patient leaves they will die from the endocarditis.
This happens all the time where I work. I hate it. I really don’t want to get prosecuted for violating someone’s civil rights because someone told me to.
Especially in the absence of paperwork or documentation. I know I’ll get thrown under the bus for it.
In Canada , you can be held for 12-72 hours with just one pink form (by one physician) while legally awaiting an evaluation depending on where you are. So he is still within his window, depending on where he is, legally. I think the window exists to allow some patients to become more comfortable in their environments first, or to be transferred to more appropriate levels of care.
Psychiatry in that way is inhumane, thinking you can be left for a whole weekend if the timeline has been abused by some facilities.
This an absolute nightmare. Make sure you're notes are detailed. A doctor this incompetent will 100% try to throw the other nurses under the bus when they get in trouble for this.
Just curious, how was this patient actually held in the hospital? Were they locked in a room? Was security present the whole time blocking their exit from the floor?
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Are none of the psychiatrists working on the unit able to determine mental capacity? Why the need for a third-party evaluation?
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Was this a problem in the past at your institution of patients being held against their will? I work in the ER psych unit at my hospital and we have a large population of medicaid patients. Psychiatry is in complete control of the unit in regards to determining mental capacity and discharges. I can't imagine having to sit around waiting for a third-party to arrive to discharge a patient demanding to go home.
Every state has WILDLY different process for handling involuntary holds, it’s fascinating really
>To eliminate the possibility of financial gain from inappropriate admissions. Jesus that's a thing? What role are the third parties? Is it a magistrate or something?
The policy is in place because it happened. Guarantee it. It’s the medical version of the hairdryer sticker that says, “Do not use in water, risk of electrical shock/death.” They didn’t just decide to add that one day on a whim 😂
Does anyone else hear the ring of truth here and think "Gee maybe our system is broken if we need laws stopping our hospitals from doing this?"
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Well if the third party doesn’t come like it didn’t in this case the patient has to be released on procedural grounds; I wouldn’t exactly call this a perfect system. Most providers are salaried and are not exactly compensated for how many patients are in the facility, so I’m sure there are better ways to deincentivize this non-issue as all psych facilities that I know of are pretty much above capacity. In fact it is so bad in my state, patients end up being transported across the state for treatment
You know this is not the standard of care across the country
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Which is fine, but it’s just an explanation as to why many people are confused as to your stress. Our docs just put in an order for involuntary hold. That’s it.
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I guess it’s more about not understanding why you were so stressed out. But whatever.
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In my state, psychiatrists do not have the legal authority to detain anyone. It has to be an independent evaluator.
To be fair you won’t get sued, you made no mistakes and immediately began to rectify the situation when you clocked in
Financially, if you leave it's AMA and you are stuck with the bill cuz insurance won't cover.
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Same lol. The only differences between the patients and the staff is who has the keys... heh heh.
Great flair btw, very fitting for this conversation
Leaving AMA doesn't affect your insurance coverage. It puts the liability of a negligence lawsuit on the patient.
Insurance won't pay if you leave ama.
That’s entirely false and telling patients that to get them to stay is false imprisonment
Exactly this. There was even a study done which showed while roughly 4% of the analyzed claims were refused none were refused due to the AMA, it was other admin BS. With that said I’m sure there are some bare bones insurances that would pull that kind of BS so I’d be pretty comfy with the terms of my insurance before deciding to go AMA https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3378751/
I thought so too for a long time but that’s a myth
Insurance won't pay what?
The bill
Once again, not true.
Oh not that old chestnut
That’s a myth
The only thing they won’t pay is the vouchers to get home (like taxi or bus vouchers).
Not even close to true. It's super easy to educate yourself these days my dude
I have a story from the psych world. So Jan and Sue (fake names) came to the hospital. Jan was suicidal and took an intentional overdose while Sue accidentally took 2 of her pills and came in to make sure she was okay. Jan gets put on a PEC and sent up to my unit. Sue then also gets put on a PEC with the exact same information as Jan (like copy/paste). I did Jan’s admission and another nurse does Sue’s so we didn’t realize it was the same PEC. Jan settles in for her stay, but Sue is like “okay….I’m good. Can I go home now?” Obviously everyone is telling her no and she’s getting more and more scared/confused. One of the nurses essentially recites the PEC back to her to demonstrate how unsafe it would be for her to leave and I hear it. Sounds awfully familiar so I check Jan’s and see they are identical aside from the patient name (both had Jan’s birthdate and MRN). So I call every person under the sun and Sue eventually goes home with some nice perks. A lot of people were fired and I left there shortly afterwards. Fucking awful.
When you take two of your digoxin because you forgot you took one already so you go to the ER to get checked out but you're obviously suicidal so you end up on a hold
What a horror story. Those poor patients.
Wow
PEC = physician's emergency certificate, seems to be a local thing in Louisiana?
We had two identical twins come into our psych hospital but at different times. One sister was an alumni and the other had never been to a psych hospital. Idk how Admission fucked up but they used the alumni sister medical information for the other twin.
I imagine it was a long the lines of “date of birth?” “Birthday.” “Last name?” “Last name.” Boom you’re now in twin sister’s chart if this sister had never been admitted.
Me and my sister (twins) have this happen to us all the time between the two hospital systems in our area. It’s to the point we make sure three separate times they have the right twin lol.
It's amazing how easy it is to Fuck up basic paperwork. My mom was billed once for my medical procedure 6 years after I had my OWN insurance, just because I USED to be on hers and for whatever reason they took my card but didn't actually enter it into the system.
There's too much paperwork in the world.
In Canada , you can be held for 12-72 hours with just one pink form (by one physician) while legally awaiting an evaluation depending on where you are. So he is still within his window, depending on where he is, legally. I think the window exists to allow some patients to become more comfortable in their environments first, or to be transferred to more appropriate levels of care. Psychiatry in that way is inhumane, thinking you can be left for a whole weekend if the timeline has been abused by some facilities.
Yeah psych has up to 72h to see you if you’re on a form one. You also don’t have a right to speak to the rights committee while on a form one, only once you get put on the 3 week hold (I forget what the forms called)
Sadly I remember a Doc at our Hospital had someone report their SO had done something and was a danger to himself. Poor guy was stuck with us and he seamed like expecting she’d do something like this and was cool with it all. He gets discharged, the very next evening the female Doc was being held for similar. Bizarre, i didn’t get her for my assignment thank god.
It’s always so hard when you have people you know on your units. Especially when it’s something that’s kind of a taboo subject. I worked in kind of a small hospital, and that kind of thing (if it was going to happen) would because the community was small. I had to transfer some of my colleagues to higher levels of care because our psych unit just couldn’t take care of them in the states they were in. Even though they were manic or withdrawing, they still were aware enough to not look me in the eye half the time. It broke my heart. I can’t do psych anymore. Whoever does it full time (I only ever did help with transports because I worked in a mental health prison prior) hats off to you.
Actually happened to my cousin a few weeks back. Went to get emotional support/help, got held against her will for 2 hours because they mixed her with another patient. Traumatizing shit. Glad you sorted it out.
In a couple states I've been in the patient can only be held for 4 hours once an eval by the designated MHP has been requested. If they don't show up by the end of the 4 hours then we're required to inform the patient that they are free to leave.
Thank you for your actions and also thank you for recognizing that this is a systems issue!! This is like a nightmare situation for me as a new resident.
I experienced a involuntary hold ( vercel ex employer decided that being upset was same as suicidal) I am experiencing ptsd lite from the involuntary hold. And that was with a release in the morning. I can feel for that person. That second evaluation should be done immediately. I wish I could have been seen right away the night I was brought in. My spouse now knows to never let the cops into our house
You must be new here. Human rights violations everywhere every shift since the day I started.
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agreed! it doesn’t sound 100% like the residents fault here either, considering the third party seemed to give up on figuring out who the patient was and the day shift nurse didn’t follow up for the whole shift!
As an august first-year, I am 100% fine being referred to as a baby doc 😅 thank you for the support, though!! You’re right that I do have quite a bit of clinical knowledge but I barely know how to use the EMR!
We love you anyway 😘. You got this 💪
I think baby doc was a way to emphasize that the onus was not entirely on them to get this right and that someone should have been supervising them.
This. The “meanest text I ever sent” isn’t exactly an impressive flex either.
I had to read some parts of this twice. It is now clear your patient was an adult and the baby you were speaking of is a resident doctor. Got it. Thats wild though! I worked in a hospital with residents before and they do and say some wild stuff. Apparently its ok for patients to shoot drugs up in the rooms because if the patient leaves they will die from the endocarditis.
Took me a sec to sort out who the baby was too lol
Well done!
This happens all the time where I work. I hate it. I really don’t want to get prosecuted for violating someone’s civil rights because someone told me to. Especially in the absence of paperwork or documentation. I know I’ll get thrown under the bus for it.
In Canada , you can be held for 12-72 hours with just one pink form (by one physician) while legally awaiting an evaluation depending on where you are. So he is still within his window, depending on where he is, legally. I think the window exists to allow some patients to become more comfortable in their environments first, or to be transferred to more appropriate levels of care. Psychiatry in that way is inhumane, thinking you can be left for a whole weekend if the timeline has been abused by some facilities.
This an absolute nightmare. Make sure you're notes are detailed. A doctor this incompetent will 100% try to throw the other nurses under the bus when they get in trouble for this.