Mrs. Mack’s daughter was referring to me changing her mother’s status from “inpatient” to “outpatient.” If Mrs. Mack was discharged as an outpatient, she wouldn’t be able to afford to go to the nursing home she needed to make a full recovery, and her daughter couldn’t care for her at home.
Physicians and hospital are all too familiar with this scenario. When a patient stays inside a hospital building, they can be either an inpatient or an outpatient. A patient can be either in an inpatient status or an outpatient status, yet stay in a hospital bed overnight and receive identical care. The ‘2 Midnight Rule’ serves to put this determination of status in the hands of doctors, but somehow, physicians like those in the Society of Hospital Medicine and the American Hospital Association dislike this new responsibility.
When I work as an emergency physician or an internist, I used to have to explain to patient families that this status designation is not in my hands.
Mrs. Mack’s daughter was in a precarious situation, but not an uncommon one; I’ve heard similar requests from patients and their families, and with good reason.