I recently completed a gerontology placement where a patient of mine was discharged following the physiotherapist's approval, the physiotherapist (student) in this case being me. At the time of the discharges I didn't believe the patient weas safe to be discharged but the team collectively advised me that they would not benefit from any further inpatient stay.
The patient was an elderly gentlemen (in his 80's) who had come in with multi-focal infarcts and had also had a fall. This patient lived at home with his wife and had only minimal services to provide cleaning every fortnight. For the patient to be discharged back home he needed to be safe and independent with all bed mobility tasks and ambulation as well as having adequate balance and saving responses, this is what I had an issue with.
The patient repeatedly failed to display adequate or safe saving responses with external perturbations and would also trip walking onto or over steps at least 40% of the time. Apart from this he was functionally independent. It was believed by the team that he lacked some insight into his behaviour.
This patient seemed functionally safe and independent but upon closer inspection had significant issues, which prompted me to discuss with my supervising physiotherapist the discharge options for this patient.
Ultimately it came down to the patients refusal of any services, the team were 100% correct in advising me that he would not benefit from any further inpatient stay and the patient refused any rehabilitative services offered by allied health. This lead to the patient being sent home with a four wheel walker he was to use when walking outside, a less than optimum outcome given his almost non impaired gait.
If the situation arised again, hopefully I would be more experienced and have a better idea of what options are available to me, not to necessarily force them on the patient, but to be able to convince him or her to take the safest discharge option available.
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2 comments:
I was curious as to how you came to the decision that the team were 100% correct in advising you that the pt would not benefit from further inpt stay. Were they correct in advising you, or correct in their advice? It does get easier to refer on to other services with practice. Did your supervisor say that a referral to day hospital would have been good for this pt to get him out of home (ie ensure some exercise tolerance is regained post hospitalization) and work on his balance?
The main problem I had with the patient was that he would be going home where he would be unsupervised for some time. He would be getting outpatient PT in his home as he is a DVA gold card holder and this could help with his balance. But I was just worried about those times beofre his balance is improved when he is still unsupervised and a high falls risk.
The ward does not usually keep pt's for longer than 2 weeks and the pt did not agree to go to a restorative unit as he wished to go home.
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